Automated Eligibility

If you fail to verify patient eligibility prior to delivering services, your financial and patient management process can really suffer. Co-pays may be wrong. Services you thought were covered may not be. And incorrect claims may be submitted, forcing you to resubmit them (perhaps more than once). In the meantime, your account receivables continue to grow. If this sounds familiar, rest assured you’re not alone. Clinics and hospitals throughout the U.S. report millions of dollars in lost revenue simply because of eligibility problems.

We offer you a way to avoid this all-too-common problem. We can automatically verify patient eligibility before an appointment by receiving a file from your office in a variety of methods and formats. The resulting data and report we provide will enable your staff to resolve any issues long before the patient arrives at your office, including issues with self-pay patients that may be covered by Medicaid.

One of the biggest headaches associated with verifying eligibility is the immense staff time it takes to make phone calls and enter individual patient data into a computer. By automating this process, your staff can automatically receive detailed eligibility reports allowing them to use the time for other productive tasks.

Getting Started:

1. Consider whether automated processing can be of benefit to your practice site.
2. Evaluate the practice site’s technical ability to create request files for processing.
3. If request files can be created decide on the appropriate method to send us data.
4. Decide on the response file format desired.
5. Contact MedData for specification and technical support.

Pricing for this service is dependent on several factors including:

• Technical support required from MedData to enable and support the service
• Estimated number of requests to be processed within a month
• Estimated types of payers to be processed within the month

General Concept

MedData automated processing is geared toward medical practices who would like to verify the health plan coverage of their scheduled patients prior to their arrival in the office. This process allows verification that may include any number of inquiries to any of the MedData supported health plans.

File Formats:

The file of requests is prepared for MedData by using one of the following file formats:

Sending the batch to MedData

The batch can be sent to MedData in one of three ways – Manual File Upload Automated URL File Upload or Secure FTP.

1. Manual File Upload:
   • The file is manually uploaded through the MedData web site. Using this tool, the site can upload their file and then retrieve it a short time later depending on how may eligibility requests there were to be processed.
2. Automated URL Method:
   • The file may be automated and sent to MedData via a URL after running a “URL encoding” process. This automated process allows a site to schedule their processing of the file.
3. Secure FTP:
   • The file may be automated and sent to the MedData Secure FTP folder. We then process the file and pass back the repose to you via the MedData website and can also pass back an ANSI 271 file or XML file to you via the Secure FTP folder.

The batch response file

The response file is returned in one of three broad formats – “PDF Report”, “Machine Readable XML Report” or “Raw EDI Data File”. Contact us at 1-877-633-3282 or at 1-800-233-7768 for a more detailed specification. We also have experience in custom development and private label solutions