Implementing Electronic Insurance Verification (e-Verify)

Electronic Insurance Eligibility Verification, or e-Verify, enables you to update insurance eligibility information for patients being scheduled at your facility in a matter of seconds without the hassle of picking up the phone. The feature works by sending one, or even multiple, eligibility requests electronically your clearinghouse vendor and receiving an electronic response from that vendor to update your patients' verification records.

The patient's insurance verification information is presented as a readable report that will be saved with the verification request for future reference. Requests can be made based on a scheduled date of service or based on the entry date of the appointment. The entry date request enables you to verify coverage days, weeks or even months ahead of the scheduled date of service. Follow up requests can then be performed by date of service as they draw closer. This functionality enables you to verify and re-verify coverage for any changes to the patient's record.

AmkaiSolutions offers e-Verify as an add-on service that is available for purchase.

Setup

Before setting up the module, please obtain a database "key" update from Client Services. The key is required for installation of e-Verify.

To verify that you have the correct key, click the Help menu at the top of the screen, and then click About AE. The About AE dialogAbout AE dialog appears. Click the License link to display the License Information window. Find the name of the Business Entity into which the module will be installed and find the column named EVER. If there is a check in the box, then a module can be installed. If the box is blank, contact Client Services to request an updated database key.

Roles (Permission Checkpoints)

When implementing Electronic Insurance Verification, you will need to edit any RoleYour organization will create Roles in AmkaiOffice that include specific system privileges and assign those roles to one or more users. Each user inherits all the privileges assigned to his/her role in the system, and only those privileges. Assigning roles is a way to limit users to only those system tasks that they authorized and trained to do. that may need access to the following areas:

Scheduling

Electronic Verification. This checkpoint would need to be set for any Role that will need to verify insurance coverage from the Scheduling Module.

Demographics

Electronic Verification. This checkpoint would need to be set for any Role that will need to verify insurance coverage from the Demographics Module.
Electronic Verification History. This checkpoint would need to be set for any Role that will need to view the history of past verification requests from the Demographics Module.

System Administration > Dictionaries

Electronic Insurance Verification. This checkpoint would need to be set for any Role that will need to add or edit data in this dictionary.
Insurance Plan. This checkpoint would need to be set for any Role that will need to add or edit Electronic Insurance Verification module information for the plan.

To learn how to edit Roles, click here.

Electronic Insurance Verification Dictionary

Settings need to be entered in the Electronic Insurance Verification dictionary for each new vendor that provides electronic insurance verification. Click here to learn how to enter settings for a new vendor if you are on AmkaiOffice version 3.17c or later. Click here if you are on an earlier version.

Insurance Plan Dictionary

Once a vendor is set up in the dictionary, the vendor needs to be assigned to insurance plans for which eligibility verification will be sent electronically. This setup step is performed in the Insurance Plan dictionary. Click here to learn how to edit this dictionary if you are on AmkaiOffice Version 3.17c or later. Click here if you are on an earlier version.

Optionally, you can assign plans to the vendor from the Insurance Carrier dictionary. This may be the easier option if one carrier has multiple plans. Click here to learn how to edit the Insurance Carrier dictionary (Version 3.17c or later). If you are on an earlier version, click here.

To assign the vendor to an insurance plan

Edit the plan from either the Insurance Plan dictionary or list of plans associated to a carrier in the Insurance Carrier dictionary by double-clicking the plan entry.
On the plan screen, there are two fields which need to be filled in:

Electronic Insurance Verification field. Select a vendor value from the drop down list. This list pulls from the Electronic Insurance Verification dictionary.
Verification Payor Code field. Enter the payor code associated to the plan for verification purposes. These payor codes can be different than the payor codes used for claims submission. If the codes are the same, simply copy the payor code from the EMC Payor Code field and paste it into this field.

If editing the plan entry directly from the Insurance Plan dictionary screen, click Save and Done to complete the action. If editing via the plan list in the Insurance Carrier dictionary, click OK to close the plan editing screen and then click Save and Done to save the carrier entry.
Repeat this process for all payors/plans for which eligibility will be checked electronically.

Note: The ability to send electronic eligibility requests to a vendor is based on the vendor's payor code list.

Using Electronic Insurance Verification

Click here to learn how to use Electronic Insurance Verification after setup steps have been performed.