Validate Policy Number and Automatically Select the Next Available Eligibility Search Criteria

Configure Eligibility Search Criteria

Automatic Eligibility Validation

Manual Eligibility Inquiry

What’s New

• Automatic eligibility workflows now evaluate configured search criteria in priority order.
• Search criteria with missing required information are automatically skipped.
• The first valid search criteria is used to submit the eligibility inquiry.
• Only one eligibility inquiry is submitted per workflow event.
• If no valid search criteria are available, no inquiry is triggered.
• Manual eligibility inquiries now validate required patient and insurance information before submission.
• Users receive a validation message listing all missing required fields when an inquiry cannot be processed.
• When no plan-specific search criteria are configured, the system automatically uses the Default search criteria.

How It Works

• Configure one or more eligibility search criteria for an insurance plan.

• During an automatic eligibility workflow, the system evaluates each configured search criteria in priority order.
• Criteria missing required patient or insurance information are skipped automatically.
• The first valid search criteria is used to submit the eligibility inquiry.
• If no valid criteria are available, the inquiry is not submitted.
• For manual eligibility inquiries, select a search criteria from the available options.
• If required information is missing, the system displays a validation message identifying the missing fields.

• If no plan-specific search criteria exist, the system uses the Default search criteria.

Benefits

•  Automatically selects the first valid eligibility search criteria without user intervention.
• Reduces failed eligibility inquiries caused by missing required information.
• Eliminates unnecessary eligibility requests by submitting only one inquiry per workflow.
• Provides clear validation messages to help users resolve missing information quickly.
• Improves eligibility processing reliability across automatic and manual workflows.