Check Eligibility & Benefits

The application is integrated with the Real-Time Eligibility & Benefits Checks service provided by the Availity clearinghouse. In addition to eligibility, the response from the insurance company can provide a variety of information about the client's coverage. This can include deductible and co-pay amounts.

What is a Real-Time check?

A real-time Eligibility & Benefits check queries the insurance company's server and a response is returned almost immediately. This can help you avoid calling the insurance and allows you to spend more time with your clients.

Perform a Check

1. Navigate to Clients > Client List.
2. Locate the desired client and select the  icon.
3. Click Eligibility & Benefits.                                                                                      
4. If the client has a valid insurance for an eligibility check, use the drop-down menus to specify what benefits to check.                                                     
5. Select Run Check. The results will be displayed in the current window.

Limitations

The information that is displayed is merely the response that was received from Availity and we cannot assist with interpreting the results. We are also unable to assist with errors as the information is funneled through a third-party service.

Available Insurance Companies

IMPORTANT: The Availity clearinghouse has switched their services to a paid model. They switched many of their payers to an Advanced list. To avoid adding additional costs to your clinic, only insurances that are listed on their Basic payer list are available for the Eligibility & Benefits service.

• Avmed, Inc (Payer ID - 59274)
• Blue Cross Blue Shield of Florida (Payer ID - 00590)
• Blue Cross Blue Shield of Illinois (Payer ID - 00621)
• Blue Cross Blue Shield of Kansas City - Freedom Network (Payer ID - 31478)
• Blue Cross Blue Shield of Minnesota (Payer ID - 00720)
• Blue Cross Blue Shield of New Mexico (Payer ID - 00790)
• Blue Cross Blue Shield of Oklahoma (Payer ID - 00840)
• Blue Cross Blue Shield of Texas (Payer ID - 84980)
• Caresource of Ohio (Payer ID - 31114)
• CIGNA (Payer ID - 62308)
• First Great West Life & Annuity Ins Co (Payer ID - 80705)
• Florida Health Care Plans (FHCP) (Payer ID - 59322)
• Fresenus Medical Care Health Plan (Payer ID - FMCHP)
• Generations Healthcare (Payer ID - GHEDI)
• Golden Triangle Physician Alliance (Payer ID - GTPA1)
• Great West Life & Annuity Ins Co (Payer ID - 80705)
• Harmony Health Plan of Illinois (Payer ID - 14163)
• Harmony Health Plan of Indiana (Payer ID - 14163)
• HealthEase (Payer ID - 14163)
• Heritage Physician Network (Houston) (Payer ID - HPN11)
• Humana, Inc (Claims) (Payer ID - 61101)
• Lincoln National (Humana) (Payer ID - 61101)
• Medicaid - Florida (Payer ID - 77027)
• Memorial Clinical Associates (Payer ID - MCA11)
• Northwest Diagnostic Clinic (Payer ID - NWDC1)
• SelectCare of Oklahoma - Tribute (Payer ID - SCOK1)
• SelectCare of TX (Houston) (Payer ID - HPN11)
• SelectCare of TX (Integranet) (Payer ID - ILNET1)
• SelectCare of TX (Kelsey-Seybold) (Payer ID - KLSY1)
• Staywell (Payer ID - 14163)
• Texan Plus (Houston) (Payer ID - HPN11)
• Texas First Health Plans (Payer ID - TX1ST)
• Texas First Health Plans (TIOPA) (Payer ID - TOPA1)
• United Healthcare (Payer ID - 87726)
• United Behavioral Health (Payer ID - 87726)
• WellCare (Payer ID - 14163)
• WellCare CT (Payer ID - 14163)
• WellCare HMO (Payer ID - 14163)
• WellCare of Georgia (Payer ID - 14163)