Capture and Display Plan/Product Type from Eligibility on Charge Page

Capture Plan Type from Eligibility Response

View Plan Details on Charge Page

Review Additional Plans

What’s New

• Plan Type (EB04) and Plan Description (EB05) are captured from successful eligibility responses.
• Plan details are stored at the charge level for the specific Date of Service (DOS).
• Supports multiple eligibility runs across different DOS without overwriting previously stored values.
• Plan information is displayed on the Charge page for:
  – Primary plans
  – Secondary plans
  – Tertiary plans
  – Additional plans
• A new umbrella icon is displayed at the end of each plan section.
  Umbrella icon color indicators provide eligibility status visibility:
  – 🟢 Green: Eligible
  – 🔴 Red: Not Eligible
  – 🟠 Orange: Additional Plan/Payer
• Hovering over the umbrella icon displays:
  – Eligible / Not Eligible status
  – Manual-E / Manual-NE status
  – Plan Type
  – Plan Description
  – Additional plan details
• Additional plans are summarized using the format:
  – Plan Name + Count (e.g., Aetna +3)

How It Works 

• Run eligibility for a patient using a specific Date of Service (DOS).
• The system retrieves Plan Type (EB04) and Plan Description (EB05) from the eligibility response.
• The retrieved values are stored at the charge level for the selected DOS.
• Navigate to the Charge page.
• Review plan information displayed for Primary, Secondary, Tertiary, and Additional plans.
• Hover over the umbrella icon to view detailed eligibility and plan information.
• If eligibility is run again for a different DOS, the system stores the new plan information separately without affecting previously stored values.

Benefits

• Improves billing accuracy by associating plan type information directly with the charge and DOS.
• Reduces manual effort by eliminating the need to reference eligibility responses separately.
• Enhances decision-making with visual eligibility indicators and detailed plan information.
• Improves auditability by preserving plan details for each DOS independently.
• Streamlines charge review and validation workflows for billing and RCM teams.
• Supports complex insurance scenarios involving multiple plans without cluttering the user interface.