What real-time eligibility is
A real-time eligibility request checks with an insurer electronically, in seconds, whether it has a particular patient’s policy on file and what that policy covers. The response shows the practice, before the visit, whether the patient has active insurance and what the patient will owe, which is the most reliable way to prevent the eligibility denials and surprise balances that otherwise appear weeks later on a remittance.
How it works in Iridium Suite
Iridium Suite connects directly to insurers and shows the payer’s response in seconds: coverage verification and the current billing information for the policy. The check runs at scheduling and again at check-in, so a change between the two is caught.
Iridium Suite also uses the response. It can create or update the patient record from it, generating demographics and policy data directly from the insurer’s response, so nobody keys information the payer has already confirmed, and the policy on the claim matches the policy the payer has.
Why it matters most in oncology
A course of treatment runs for weeks, and coverage changes in the middle of it: a new plan year starts, a patient becomes eligible for Medicare, a secondary policy is added. Checking at each visit keeps the coordination of benefits correct through the course and gives the practice time to resolve prior authorization before the next fraction, not after the denial.
Frequently asked
What does a real-time eligibility check return?
Whether the payer has the policy on file and active for the date of service, and the benefit detail the payer returns with it, such as plan type, deductible, remaining deductible and copay or coinsurance.
When should eligibility be checked?
At scheduling, so a lapsed policy is caught while there is time to call the patient, and again at check-in, because coverage changes between the two.
Can the response create the patient record?
Yes. Iridium Suite can build the patient's demographics and policy from the payer's response, so staff do not key data the payer has already confirmed.
Which payers can be checked?
Any payer that supports the electronic eligibility transaction, which is most commercial payers, Medicare and the state Medicaid programs, through the built-in clearinghouse connection.