Create eligibility request

Eligibility request is sent to the payer to confirm that a patient is eligible for health insurance coverage. The user may send it to Post Office right away or save it to draft to postpone sending. Besides, the request is saved to draft automatically if it had errors and failed to upload to Post Office; in this case user has an ability to edit the request and send it again.
 

Step 1. Select Requests > New Eligibility from the menu.
       Electronic Prior Request - Eligibility form opens. Patient Details tab is active.

Step 2. Select patient using Find Patient field.

Step 3. Go to Request Details tab and enter visit details.

Step 4. Click on Save & Send button.
       A warning dialog appears informing that the request is sent to Shafafiya. 

Step 5. Click OK button.
       Electronic Prior Request form closes. Menu panel shows if there are new transactions to download.

Step 6. After the files the payer replied with are downloaded, click See today's authorizations.
       Find Prior Requests form opens. 

Step 7. Select the request and click on View button.
       All data becomes disabled on Electronic Prior Request form. Payer reply section appears on Request Details tab. Summary tab adds at the end (see its details in authorization). 

ALTERNATIVE WORKFLOWS

Save eligibility request as draft

1. Select Requests > New Eligibility from the menu. 
   Electronic Prior Request - Eligibility form opens. Patient Details tab is active.
2. Select patient using Find Patient field.
3. Go to Request Details tab and enter visit details.
4. Click Save as Draft button.
   An information dialog appears saying that the request is saved into the database.
5. Click on OK button.
   Electronic Prior Request form closes.

Create eligibility request from Find Prior Authorization Requests form

1. Click Find Prior Requests button. 
   Find Prior Authorization Requests form opens.
2. Click on Add button.
   Electronic Prior Request - Authorization form opens. Patient Details tab is active.
3. Select patient using Find Patient field.
4. Go to Request Details tab, set Request Type = Eligibility and enter visit details.
5. Click Save & Send button.
   A warning dialog appears informing that the request is sent to Shafafiya.
6. Click OK button.
   Electronic Prior Request form closes.