Auto-fetch Eligibility for Cost Estimation and Show Eligibility Prompts Consistently

What’s New

• Eligibility is automatically fetched when generating a cost estimate and no prior eligibility exists for the selected Date of Service (DOS).

• Eligibility responses older than 24 hours for the same DOS are automatically refreshed.

• Cost Estimator displays the same eligibility messages shown on the Insurance > Eligibility screen.

• Cost calculations always use the most recent eligibility response that matches the selected DOS.

How It Works 

• A user opens the Cost Estimator and selects a Date of Service.

• The system evaluates eligibility data for the selected DOS.

• If no eligibility exists for the DOS, the system automatically initiates an eligibility inquiry.

• If an eligibility response exists but is older than 24 hours for the same DOS, the system automatically sends a new eligibility inquiry.

• The Cost Estimator uses the latest eligibility response for benefit and cost calculations.

• If the payer does not support future eligibility, the same message shown on Insurance > Eligibility is displayed in the Cost Estimator.

• Cost estimation proceeds using current, DOS-matched eligibility data or displays appropriate messaging when eligibility cannot be retrieved.

Benefits

• Ensures cost estimates are based on current and accurate eligibility data.

• Eliminates reliance on manual eligibility checks within the Cost Estimator.

• Reduces errors caused by outdated or missing eligibility responses.

• Provides consistent and clear eligibility messaging across workflows.

• Improves operational efficiency and reliability of patient cost estimates.