Eligibility Checking

Practices that using an integrated clearinghouse like Waystar or Change Healthcare can use Valant for checking patients insurance eligibility. Practices should make sure their payers are enrolled payors for eligibility checking at the clearinghouse level and make sure that the Eligibility ID is input for the insurance company in Valant. 

Each Insurance company must have EDI Payor ID and an Eligibility ID supplied by Waystar. For ChangeHealthcare the EDI Payor and the Eligibility ID are the same. The following step will only need to be completed once in the initial setup. 

  1. Click Persons and Institutions | Insurance Company
  2. Select a payor and enter EDI payor ID and the Eligibility ID"
  3. Click Save


There are three options to run eligibility checks in Valant: 

Persons and Institutions | Patients | Insurance Tab

One way to run an eligibility check is from the Insurance Tab of the patient demographics. This is used mostly when adding in insurance for a new patient, or updating insurance payors for a patient. 

  1. Navigate to Persons and Institutions | Patients | select a patient | Insurance tab
  2. Select a payor assigned to the patient
  3. Click Check Eligibility
  4. This will open the Eligibility Check window. Click Check Eligibility
  5. The response from the payor will show in the window and a full results file can be viewed by clicking View Results File

Scheduler

Eligibility Checking can be done on the scheduler. This is most useful when you are scheduling an appointment or before an appointment for a patient that already exists in the EHR. To do eligibility checking from the Scheduler:

  1. Right-click on an Appointment |  Check Eligibility 
  2. This will open the "Eligibility Check" window, then click Check Eligibility
  3. The results will be returned an users can review the results file

Batch Eligibility Checks

Users also have the option of running Batch Eligibility checks. This will be for a large number of patients at once and often time gives less details about coverage than an individual eligibility checks like the methods above. This solution is for verifying active coverage for a large number of patients. Maybe say a whole week or days appointments.  

Click Biller Tools | Batch Eligibility Checking

 The patients can be filtered either by their demographic information or by the appointments scheduled in the calendar.

The eligibility check itself is based on the patient’s primary insurance. Specify which patients will be included in the eligibility request batch by using the controls described below.

Demographics Radio Button: only active patients whose demographics match the criteria will be included in the resulting batch eligibility request.

  •     Assigned Provider Drop-down: filter the batch eligibility request by patients' assigned providers.
  •     Insurance 1 Drop-down; filter the batch eligibility request by patients' primary insurance.
  •     Insurance 1 Type Drop-down: filter the batch eligibility request by patients' primary insurance types.

Appointments Radio Button: only patients with a scheduled appointment will be included in the batch eligibility request.

  •     Appointment Date Range: filter the batch eligibility request by appointment date.
  •     Service Provider Drop-down: filter the batch eligibility request by service provider.
  •     Service Facility Drop-down: filter the batch eligibility request by service Facility.
  •     Insurance 1 Drop-down: filter the batch eligibility request by patients' primary insurance.
  •     Insurance 1 Type Drop-down: filter the batch eligibility request by patients' primary insurance types.

Report Name Field: indicates the name of the resulting batch eligibility report as displayed in the Report Queue.

Report Description Field: (Optional) provides an optional description of the report.

Clear Button: clears all controls on the Batch Eligibility Checking Tab.

Submit Eligibility Request: sends the batch eligibility request to the partnered clearing house. When a response is received, the eligibility information is sent to a report that is accessed from Report Queue.

Click Tools | Report Queue

Eligibility Check Report

There are three sections of the report. The responses to these batch eligibility checks are only located in this report.

  1. Active Coverage: the patients listed here all received a valid response from the payer for the eligibility check.  This response represents a general message from the payer and may or may not apply to the services specified in the appointment. In order to get complete details of the check, an individual eligibility check on the patient must be run from Persons and Institutions | Patients | Insurance 1 Tab.
  2. Inactive/Other: this area lists the patients which did not receive a valid response from the payer for the eligibility check. The reason for appearing here is that either the patient is not covered by that payer anymore or else another payer is responsible for covering the patient. The specific reason is supplied under the Response column next to the patient name
  3. Response Error: this section of the report is meant to display any response that came back due to a specific error. When possible, we include the error response from the payer in the report, however this might not always be available. It is advisable to run an individual eligibility check on the patient from Persons and Institutions | Patients | Insurance 1 Tab in order to get more details on any error messages which are unclear or require further information.
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