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, the user has the 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 a patient using Find Patient field.

Step 3. Go to Encounter Details tab and enter the visit details.

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

Step 5. Click OK.
       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 View.
       All data becomes disabled on Electronic Prior Request form. Payer reply section appears on Encounter Details tab. Summary tab adds at the end (see its details in authorization). 

ALTERNATIVE WORKFLOWS

Save eligibility request as a draft

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

Create eligibility request from Find Prior Authorization Requests form

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