Check Insurance Eligibility for your Patients
Before getting started, note that to verify a patient’s eligibility, your setup needs to be completed:
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Patient insurance information needs to be added from your Contact List in the Insurance tab of their Patient Profile. Refer to the Get started with insurance billing article for step-by-step instructions for setting up your Contact List.
For the eligibility check to function properly, the information on the patient’s insurance tab must be accurate.
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Billing provider information needs to be completed under Settings.
OptiMantra’s eligibility tool utilizes the NPI from the default billing provider specified in the Provider Settings Profile. This is located under Settings > Business > Provider Settings.
Ensure that the NPI associated with your credentialing is entered correctly so you receive accurate eligibility information.
To perform an eligibility check, follow the below steps:
From the patients list, click the Actions menu (three horizontal stacked lines) for the patient.
Under the Admin section, click Profile.
From the patient's profile, click the Eligibility Check tab.
Select whether the insurance is primary or secondary.
Choose the provider and coverage type.
Select the payer if it’s not already listed.
Then, click the blue Check Eligibility button.
- You can bypass the Payer Portal Login and Portal Pass fields. They are only used in special cases and will be explained if needed.
→ When an eligibility check is successful, you will see a button titled "View Response" next to the "Check Eligibility" button. Click the "View Response" button view the patient's eligibility.
Note: The program automatically saves the eligibility response in the patient’s documents.
If you’ve completed all the steps above and still experience issues with eligibility checks, please submit a support ticket.