Stay up to speed on the moving target of eligibility

Front-end revenue cycle issues are a key driver of denials. And among the comprehensive causes of denials, eligibility consistently makes the top of the list. This is largely due to the fact that coverage changes occur regularly, and it’s difficult to stay on top of them all – especially with limited staff. At Netsmart, we turn to automation to address that challenge.

Eligibility automation within the RevConnect solution can help manage base coverage, exceptions and changes so that your team doesn’t have to. Pairing your clearinghouse with a strong, holistic eligibility solution powered by automation can take your team’s efficiency to the next level.

Eligibility information at your fingertips

Eligibility verification within the RevConnect clearinghouse offers visibility to coverage – and changes in coverage – so that you have the information up front to help minimize denials. Below is preview of an eligibility response once an eligibility transaction is submitted.
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  • Payer information
  • Subscriber information including dates for beginning of plan, service and beginning of eligibility
  • Primary care provider information
  • Other payer source of data information
  • Other or additional payor information
  • Health benefit plan coverage including amount, network and coverage information
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  • Outpatient coverage status including co-payment and co-insurance information

Related pages

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RevConnect Authorization Automation

This solution automatically determines if a prior authorization is required and reduces the complexity of manual prior authorization processes.
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RevConnect Coverage Discovery

This accounts receivable solution works to simplify the pre-billing process and delivers actionable so that information is adequately captured on the front end.
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RevConnect Patient Liability Statements

With this solution, you can deliver individually tailored statements that prevent you from having to manage the entire statement process from printing to mailing.

Ready to alleviate manual tasks and improve front-office workflows?

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