QuickEMR now supports benefits & eligibility lookup for over 800 payers. This article describes the setup and usage of this new feature.

Terms and Conditions for Use

Warning! This feature will incur additional charges per transaction. By using this feature you agree to these additional fees and attest that you have the authority to approve the fees on behalf of the practice. You also agree that the information received is an estimate provided by the insurance company and that QuickEMR and it's partners (Availity) give no warranty on the information and carries no liability for actions taken in response to this information. For pricing details contact our help desk at 888-495-4080 option #3.

If you feel something is incorrect reach out to QuickEMR through the help widget so we can confirm our formatting and presentation does not obscure any important information.

Enable the Feature

The benefits and eligibility check do incur an additional charge per transaction. To agree to the new charges and enable the feature visit "Settings" => "Add-Ons". Under the Eligibility & Benefits section select the clearinghouse you use to set your Payer ID's. If your Clearinghouse is not listed let us know by clicking on the "HELP" widget on the right, and please include a URL to the publicly accessible website of your clearinghouse. We will add additional clearinghouses as we get your feedback. If you do not use a clearinghouse select "No Clearinghouse". Then, if you agree to the terms and the pricing, set the "Enable Benefits" checkbox and save the page.

Summary of Required Fields

To successfully query a patients benefits several pieces of data must be correctly set inside of QuickEMR. A detailed description of how to set up QuickEMR follows but is summarized here.

• Patient Type Discipline - EDI Name: Service Type Code. 
• Facility/Practice/Organization NPI - EDI Name: Provider NPI
• Insurance Payer ID - This payer ID must match the clearinghouse set in the Settings => Add-Ons form or some insurances may not function correctly.
• Insurance Billing Type - Provider Type. Institutional or Professional.
• Insurance Billing Submitter ID - An ID assigned by a payer to your organization. Not required for most insurances.
• Patient first name, last name, and date of birth, and gender
• Policy Number - EDI Name: Member ID
• Policy Holder Relationship - Subscriber Relationship. Not required for most insurances to check benefits but usually required to submit claims.

Patient Type Discipline

Each Patient type in QuickEMR must be assigned an appropriate discipline. This is the same setting that is used to insure Discipline specific modifiers such as CQ/CO. Set this value at Documentation => "Customize Note Details" => {Select Patient Type} => Edit {Button below patient type} => "Discipline". If the discipline you need is not in the list contact us with the "HELP" widget on the right of your screen and request that we add it. The discipline requested must be one included on the X12 Service Type Code list.

Facility Setup

Most Insurance Companies require a Provider NPI. In the EDI world this usually means the NPI assigned to your organization for billing purposes. QuickEMR has added a new field to the Facility to capture this NPI and it must be filled out to check benefits. Visit Lists => Facilities => {Select a facility} => General {tab} => NPI (in the first field group). If the NPI is the same for all facilities, make sure to add that NPI to each facility anyway. Note: a benefits check will use the facility NPI of the facility assigned to the case record.

Insurance Setup

Once the feature is enabled the insurance companies in your database must be set up correctly to query the benefits information. Start by visiting your insurance company list and select an insurance company. On the General tab the "Payer ID" must be set and must match the clearinghouse selected. If you selected "No Clearinghouse", you must use the payer id specified by the payer themselves, usually listed on the insurance card.

After saving any changes select the "Billing" tab on the left. Make sure the "Payer Type" correctly reflects the institutional or professional settings.

Rarely an insurance company requires an additional Submitter ID. You will know this is the case when you attempt to check benefits for a patient and a warning appears stating: "Submitter ID is required for this insurance." In this case you will need to either provide the submitter ID given to you by the payer or obtain the submitter ID from your clearinghouse. If neither of these options work for you, let us know by using the Help widget from the case in question. As we discover which insurances require this information we will populate a list of Availity specific Submitter ID's here. Once a submitter ID is found populate it on the insurance billing tab in the field labeled "Submitter ID".

Availity specific submitter IDs.

Patient

The patient record must have the correct First & Last Name and Date of Birth that matches their insurance policy. Occasionally a payer may require the Gender as well.

Case Insurance

The Case Insurance record must have a valid policy number and many insurances require the "Patient Relation to Insured" to be populated as well.

Check the Benefits

Most steps only need to be performed upon initial setup of the feature and the remaining are part of most practices normal process. For your first benefits check find a patient using one of the private national insurance companies such as United or Aetna. Visit their case insurance tab and select the "Benefits" link on the primary policy. Here you may change the "as of" date to check past coverage or just click "Check Benefits" to use the default of todays date. The process will take about 5 seconds to return an benefits & eligibility report. From here you may:

• Read the returned report in the viewer on the right panel of the modal (4).
• View the full report in a printer friendly page by clicking on the blue printer icon (5). 
• See past reports by scrolling through and clicking on the other pulls listed on the left of the modal (6).

Reports

QuickEMR has added a report to support this feature. The Benefits Pulls report allows the user to get an estimate of how many transaction they have been or will be charged for. This report is located at Reports => Logs => Benefits Pulls. Set the date range you wish to inquire about and all pulls performed on your practice will be listed. Practices will only be charged for pulls performed by their own users with the success or pending status. Pulls performed by the QuickEMR support and billing teams are not charged to the client. A summary of the expected number of pulls being charged will be listed at the top of the results and each line item will also list charge or no charge on the cost column.

What Payers are Included?

QuickEMR uses Availity, a 3rd party clearinghouse, to obtain the Eligibility & Benefits information. The list of supported providers occasionally changes and an updated list may be found on their online payer look-up tool. In submission type select "REST (API)" and under transaction type select "Eligibility and Benefits (270/271)".