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This article provides step-by-step instructions on how to run real-time eligibility (RTE) checks in both Elation Billing and Elation EHR.

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Overview

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What is Running Eligibility?

Running eligibility (also called Real-Time Eligibility or RTE) is the process of verifying a patient’s insurance coverage status electronically. This checks whether the patient’s policy is active and may provide additional coverage details.

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Why is Running Eligibility important?

Verifying eligibility before providing services helps prevent claim denials due to inactive coverage, identifies patient responsibility amounts, and ensures claims are submitted to the correct payer.

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Workflow Instructions

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Prerequisites

Before running eligibility, you must first enroll for a Payer’s Eligibility.

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Running RTE in Elation Billing

You can run RTE from any Patient or Superbill Page.
  1. Check the Policy - Locate the patient’s insurance policy and click the Check button. Patient insurance coverage panel showing ME Medicaid (Member ID 123456789) with a last eligibility check date of 2023-08-14. An arrow points to the blue Check button used to run eligibility.
  2. Select Check Type - Choose one of the following options:
    • E-Check Eligibility - Run an electronic eligibility check with the payer
    Patient Eligibility modal showing Manual Check and E-Check Eligibility options, with an arrow pointing to E-Check Eligibility, and two ACTIVE electronic checks dated 2023-08-19 and 2023-08-14.
    • Manual Check - Manually mark a policy as active or inactive when electronic check is not available
    Patient Eligibility modal showing Manual Check (arrow highlighted) and E-Check Eligibility options, with two ACTIVE electronic eligibility records dated 2023-08-19 and 2023-08-14.
  3. Run the Check - Confirm and run the eligibility check. Patient Eligibility modal showing E-Check Eligibility section with provider "Laura Sample," Benefit Type "Health Benefit Plan Coverage," Date of Service 08/18/2023, and an arrow pointing to the Check button.
  4. View the Report (Optional) - You can view reports for both Active and Inactive policies to receive more information. Click the Report summary to view more information. The info available is determined on a payer-by-payer basis, dependent on what the payer provides. Eligibility history table showing one ACTIVE electronic check for date of service 2023-08-14, submitted by Elation Billing S at 15:15:42, highlighted with an orange border.

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Running Eligibility in Elation EHR

For Elation EHR + Billing users, RTE can also be run in the EHR. Running RTE in the EHR will update the Eligibility in Elation Billing, and vice versa.
  1. Open Patient Demographics - Open the patient’s demographics page.
  2. Navigate to Insurance - In the sidebar of the pop-up window, select Insurance, Payment, & Membership. Patient demographics sidebar for Keanu Leaves with "Insurance, Payment, & Membership" selected and highlighted, showing navigation options including Patient Details, Contact Information, Pharmacies, and Provider Information.
  3. Check Eligibility - Click the eligibility check button. Insurance, Payment & Membership section showing the "Check Eligibility" button (highlighted with arrow), with Active status, $15 copay, and Aetna coverage effective 8/8/2023–10/7/2023.
  4. View the Report (Optional) - Review the eligibility report for coverage details. Insurance, Payment & Membership panel showing Active Aetna primary insurance with an arrow pointing to the "Open Full Report" link for viewing eligibility details.

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In-Network and Out-of-Network Information

Each Eligibility report is provided directly by the payers and their own clearinghouses, and each payer offers different levels of information.
While some payers may provide information about both In- and Out-of-Network coverage, the report will not indicate NPI-specific information. For this information, please contact the payer directly.