Insurance eligibility verification
Know the coverage before the patient arrives.
Ellery asks the payer and puts the answer in plain words: whether coverage appears active, the estimated patient responsibility, and who needs a call before the visit.
One patient, a whole day, or a whole file
A check takes a name, a date of birth, a member ID and a payer. There are four ways to run one.
- One at a time. The front desk runs a check while the patient is on the phone or at the counter.
- The whole day. One button on the calendar checks every visit that day with insurance on file, and skips anyone checked in the last 24 hours.
- A whole file. Upload a CSV list of up to 500 patients and Ellery works through it at a steady pace. You can close the page and come back.
- Automatically. Ellery can check every patient on the schedule ahead of their visit: two days ahead unless you choose otherwise. It stays off until a manager turns it on, because every answered check counts toward the month.
Eligibility information and patient-responsibility estimates are informational only and are not guarantees of coverage, benefits, reimbursement, payment, or the final amount a patient may owe.
What comes back
The payer's answer, arranged so the front desk can act on it.
- Whether coverage appears active, the plan's name and group, and when the plan began or ended.
- The estimated patient responsibility for this visit, with the reason: the copay the payer returned, or the deductible that is left and the coinsurance after it.
- The deductible and the out-of-pocket maximum: what is left, in network and out.
- Benefits by service: copay, coinsurance, and whether the payer says prior authorization is required.
- The payer's own notes, in the payer's words: other insurance on file, a Medicare Advantage plan to bill instead, a referral requirement.
- Where the payer returned nothing, the result says Not returned by payer. It does not guess.
Eligibility information and patient-responsibility estimates are informational only and are not guarantees of coverage, benefits, reimbursement, payment, or the final amount a patient may owe.
Who needs a call before the visit
Needs attention lists the patients checked in the last 7 days whose latest answer needs a person: coverage not active, member not found, rejected by the payer, no answer from the payer, or active with a payer note that changes what you do. Each row says what to do next. Fix it, recheck, and the patient leaves the list.
And the whole team sees it at the morning huddle
The huddle sheet lists every visit for the day with what to collect and what needs doing before the patient arrives. Its first line is the total the desk can expect, and how many visits could not be estimated.
Eligibility information and patient-responsibility estimates are informational only and are not guarantees of coverage, benefits, reimbursement, payment, or the final amount a patient may owe.
The words are fixed, on purpose
An eligibility response is what a payer said on the day it was asked. It is not a promise to pay. So every result uses the same careful words, and never the confident ones.
| Ellery writes | Never | Because |
|---|---|---|
| Coverage appears active | Covered, approved, guaranteed | A payer's answer today is not a promise to pay a claim next month. |
| Estimated patient responsibility | The patient owes | It is worked out from the payer's response. The claim decides the amount. |
| Not returned by payer | A guess | If the payer said nothing about a benefit, the result says exactly that. |
| Unable to estimate from the available payer response | A number we cannot stand behind | When the answer is ambiguous, no estimate is better than a wrong one. |
Common questions
Which payers can you check?
Commercial plans, Medicare and Medicaid, through a healthcare clearinghouse. Some payers, Medicare among them, ask each practice to enroll once before they will answer, and we do that paperwork with you during setup. Tell us your five biggest payers and we will tell you where each one stands.
What does a check need?
The patient's name and date of birth as printed on the insurance card, the member ID and the payer. A group number and a date of service are optional. For a spouse or a child on someone else's policy, the policyholder's name as well, and their date of birth where the payer needs it.
Is the estimate what the patient will owe?
No. It is an estimate from the payer's response on the day of the check, for an in-network visit. The claim decides what the patient owes. Ellery shows an estimate only when the payer's answer is unambiguous, and says why when it is not.
What counts as a check on our bill?
A check the payer answered. A timeout, a payer outage or an error on our side does not count.
Can we see the payer's raw response?
Yes. A practice manager can open the raw eligibility response behind a check the payer answered, for 90 days after the check. Every result can be printed or saved as a PDF.
Talk to us
Book a 20-minute look. Tell us how many providers you have and what your front desk spends its day on. We will show you the app with a sample practice and answer what you ask.
- support@elleryhealth.net
- Phone
- (732) 444-7364
- Hours
- Monday to Friday, 9:00 am to 5:00 pm Eastern