Insurance Eligibility

Summary

This enhancement to Insurance Eligibility introduces the ability to write SQL Insurance Warnings on the Availity/Eligible Payer ID. Having the option to write on the Payer ID will allow for bulk insurance warnings to be written for Carrier Codes with the same Payer ID.

Previously, RIS could only write SQL warnings at the carrier code level.

With this change, Availity Payer Id and Eligible Payer Id columns have been added to the EligibilitySpecialConditions RIS Lookup Table.

This allows rules to be created that reference these new fields:

·         When one of these is specified, the rule will match when the requesting carrier code has that payer_id specified in the l_carrier table and the processing engine matches the payer_id.

·         If the carrier code and these the columns are null, the warning/filter applies to all all payers.

·         When a payer_id value is provided the rule will only apply to eligibility responses that for carriers with that payer_id.

·         Note that entries cannot have both a Payer Id and a Carrier Code; a warning message will be presented if the user attempts to configure both.

Configuration Instructions

No System Administrator actions are necessary to enable this feature; however, optional configuration is available:

RIS Client

Changes to EligibilitySpecialConditions RIS Lookup Table Settings

·         Configure desired rules using the new Availity Payer Id and Eligible Payer Id columns.

·         The following rules apply:

o    If a carrier code is specified, these new columns must be empty.

o    If a value is specified for the new columns, the carrier code must be empty.

o    Specifying an eligibility_payer_id without an availity_payer_id is supported.