Eligibility Checks

Insurance eligibility verification software tells you whether a patient has active coverage before they arrive. In PatientCopilot, you run a 270/271 eligibility check on a patient's coverage and see a plain summary of active status, copay and deductible. It is part of the Autopilot plan.

Real-time checks

An eligibility check sends a 270 request and receives a 271 response. Instead of reading raw transaction data, you see a short summary on the patient's coverage. Front desk staff can tell quickly whether coverage is active and what the patient may owe.

• 270/271 checks for a patient's coverage
• A plain summary of active status, copay and deductible
• Results saved with the coverage on the chart

Benefits detail

The summary highlights what matters at the desk. Active status tells you whether to proceed. Copay and deductible help you tell the patient what to expect. Benefit details vary by payer and plan, so treat the result as information to confirm, not a guarantee of payment.

No duplicate requests

Repeat requests are not sent twice. If someone clicks again, the system does not fire a second identical request. This avoids waste and confusion.

Save to patient

Results stay with the patient's coverage, so staff do not need to re-check or write the answer on a sticky note. The chart shows primary and secondary coverage and what was checked.

How it works

1. Open the patient's chart and review the coverage on file.
2. Run an eligibility check.
3. The request is sent and the response is returned.
4. Read the summary of status, copay and deductible.
5. Tell the patient what to expect and proceed with the visit.

When to check

Check before the first visit, and again when coverage may have changed. Many practices check at the start of each month or plan year for returning patients. For busy days, check a day ahead so surprises are resolved before the patient is in the room.

Eligibility checks are most useful when they become routine. Build the check into your scheduling process so every new patient is verified before the first visit, and returning patients are rechecked on a set cycle. Tell patients about their copay and deductible at the desk, and note any special requirements, such as referrals or visit limits, that the plan communicates. If a check shows inactive coverage, call the patient before the visit instead of at checkout. Keep a note of what the response said and when it was run. Remember that a response describes coverage at that moment and is not a promise of payment, so keep your documentation and billing accurate.

Where it stands. The clearinghouse features are under development. This page describes what the tool is designed to do, not a promise of coverage with any particular payer. Ask us for the current status before you rely on it.

Practices with a busy front desk can assign eligibility checks to one person each morning for the next day's schedule. A simple routine like this catches coverage problems early and keeps the day running smoothly.