Insurance Eligibility

Summary

This enhancement to Insurance Eligibility introduces configuration to control the workflow for the review of Manage Policies when the Historical Eligibility process completes, with options to reduce the frequency of forced review.

Previously, Feature #27732 - Attempt to autoselect historical carriers based on Eligibility check added the ability to automatically run eligibility on the patient's historical policies under certain conditions. When the results of the historical check were successful, an automatic selection of the carrier (or set of carriers) was made for the current appointment and the Historical Carrier Selection dialog informed the user of the results.

The workflow then forced users to go to Manage Policies, even if an autoselection occurred. The reasoning was that even if the patient's insurance from the prior visit is still valid, the user should visit Manage Policies to confirm the information and make changes to the autoselection if needed.

However, in real world use, autoselection has proven to be highly accurate and forcing users to visit Manage Policies unnecessary.

With this change, a new HistoricalCarrierSelectionRequiringManagePolicies system configuration offers options that no longer force review. The LowerConfidenceOnly option only forces review when autoselection was not the most recent visit and/or the most recent visit was a Self Pay. The Never option allows the dialog to be closed without review unless carrier selection failed because insurance could not be verified.

Additionally, the dialog has been updated to display additional details, including the Carrier and Policy Number for each selected insurance (in order of priority), giving users a better sense of whether they should open Manage Policies to review more closely even when not mandatory.

Configuration Instructions

System Administrators must complete the following actions to enable this feature:

RIS Client

Changes to RIS SystemConfig Lookup Table Settings

·         Configure HistoricalCarrierSelectionRequiringManagePolicies to adjust the requirement for mandatory review of Manage Policies.

The following related settings were added or updated: