Payer Eligibility Checking (ANSI 270 and 271)
Unlike the “implied” integration of so many bolt-on products, the InsightCS® Payer Eligibility Checking software system (ANSI 270/271) provides a truly user-friendly, fully integrated solution to automate the process of verifying Payer coverage on a real-time basis at the time of Scheduling and Registration. This valuable tool is paramount for organizations wishing to validate financial accountability early in the workflow process.
Key unique features and benefits include:
Service Oriented Electronic Data Interchange: The entire Eligibility Checking process can be expedited as registrars are NOT required to wait for a 271 Eligibility transaction to return before moving on to the next record. The registration or pre-admit data entry and verification process can proceed independently.
Transaction Retry: If the Payer rep at the other end of the line is unavailable to receive and respond, the system will capture the NO RESPONSE feedback and automatically trigger several retries.
Transaction Service: If a “Successful Verification” 271 comes back into the system from the Payer and the InsightCS® user is no longer logged in or has moved on to other patient registration activities, the Transaction Service will automatically complete the writing of the data in the background.
Dynamic Worklists: InsightCS® Dynamic Worklists are used to notify registrars of any missing eligibility checks where the Payer may be off-line, or the 271 response back from the Payer was not provided prior to completing
the current patient’s registration.
Superior Data Capture and Storage: Compared to bolt-on applications, InsightCS® Payer Eligibility Checking provides for the ability to capture MUCH MORE data from the incoming 271 message and store it for
use by the Patient Access and Patient Accounting applications.
Store and Forward: InsightCS® Payer Eligibility Checking utilizes a set of unique Managed Message Queues to process 270 and 271 transactions. This allows registrars to continue to submit Eligibility Request messages during scheduled (or unscheduled) Payer system downtimes. Such outbound messages are queued and automatically transmitted when the Payer system comes back on-line.
Dynamic Transaction Display: The InsightCS® Message Monitor provides the means to dynamically display both inbound and outbound transaction throughput for all electronic eligibility communications to/from the payer.