Eligibility

The Eligibility tab contains Eligibility Check functionality to ensure that Patients are eligible to receive services under Medicaid. The Eligibility Check may be set to run automatically every X number of days or at the user’s discretion.

The Eligibility Check is not a standard HHAeXchange feature. Contact the HHAeXchange Support Team for further details.

Contract Setup: Eligibility Tab

Field

Description

Enable Eligibility Check

Eligibility Checks track the status of referrals and Patients to ensure they are covered for services. Select this checkbox to enable the rest of the options in this section.

For Selected Payer

Select the Payer Source to use when performing Eligibility Checks for this Contract’s Patients.

Ad Hoc Eligibility Check

Click the Run button to generate an Eligibility Check batch for all Patients configured for this Contract. Go to Patient > Eligibility Batch Review page to view the results of the Eligibility Batch submission.

Contract Submission Name

When submitting Eligibility Checks for this Contract, the entry in this field is used instead of the Contract Name (as configured on the Contract Profile). This field is required.

Medicaid Direct

Select this checkbox if the Contract provides service to Patients who are directly covered by Medicaid. When selected, the Eligibility Check process correctly identifies which Patients are covered by Medicaid.

Run Automated Batch On

Use the radio buttons to determine when HHAeXchange is to run an automated Eligibility Check for the Patients assigned to this Contract.