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Engagement: Automated Insurance Eligibility Verification
Engagement: Automated Insurance Eligibility Verification

Learn how to verify patient insurance information within Engagement [Modento] for patients who are scheduled within the next 1-30 days

Erika Gardner avatar
Written by Erika Gardner
Updated over a week ago

Reduce your chances of providing services for patients without insurance coverage and provide your patients with more informed cost estimation with integrated batch eligibility verification within Engagement.

In this article, you'll learn more about:

Important notes:

  • Eligibility verification in Engagement is currently enabled for primary insurance only

  • In order for Eligibility to read the correct patient member/payer ID information, you must have the ID details entered into the correct fields in your practice management software. Learn more here.

  • Before you can begin using the Engagement Eligibility tab, you must be using Engagement Bridge Version 132 or higher. Click here to learn how to update your Engagement Bridge.

The Eligibility tab in Engagement requires a subscription to our DI Insurance module. Interested in adding DI Insurance to your subscription? Click here to contact a representative and learn more about getting set up.


Add Your Group / Practice NPI Information

In order to ensure that your Eligibility dashboard is functioning correctly, you must check to ensure that your Engagement account includes your group / practice NPI information. To access your group / practice NPI information in Engagement:

  1. Click on the Settings gear in the upper right corner

  2. Click on the Practice Setup tab, then click on the Insurance section

  3. Enter your group / practice NPI, then click Save


Eligibility Dashboard Overview

Eligibility verification in Engagement is currently enabled for primary insurance only. To begin verifying patient eligibility, navigate to the Eligibility tab in the Engagement left side menu.

Set up an Automatic Verification Rule or use the calendar button to populate a list of patients and view their insurance payor, appointment date, date of last verification, and current eligibility status.

Filter the populated patient list based on patient eligibility status.

Instantly verify individual patient eligibility status using the Verify All button, refresh icon or use Bulk Action to batch verify multiple patients at once.

Patient Eligibility Status Definitions

Patient lists may show a variety of eligibility statuses, depending on their insurance verification history and if additional insurance information is needed. Hover over the status in the Eligibility tab to learn more. These statuses are defined as follows:

  • Not Eligible: The patient is not eligible for insurance benefits at your practice.

  • Failed: Eligibility verification failed. Check to ensure that your server is connected to the internet and that your Engagement Bridge is connected.

  • Eligible: Patient insurance has been verified and the patient is eligible for any applicable benefits.

  • Unverified: Patient insurance details have never been verified in Engagement.

  • Info Needed: A previous eligibility check has determined that additional insurance information is needed. Add missing insurance details by clicking on the patient's name to access the Patient Card.

  • Not Supported: Please review the Carrier List in your practice management software and verify that the payer attached to the patient has the electronic ID associated with it.

  • Processing: After requesting eligibility verification for patient(s), the status will show as Processing for a few seconds while their insurance information is verified.


Patient Insurance Information in the Patient Card

Drill down into specific patient insurance details by clicking on the patient name to open their Patient Card.

In the Details section of the patient card, locate the patient's insurance status. Click on the refresh icon to review their insurance details.

Add insurance details directly in the Patient Card, then click Verify insurance.

View submitted insurance forms in the Documents section of the patient card. Choose to download the insurance form or manually send the form to your practice management software (PMS).

Please note: The PDF is automatically sent to your practice management software shortly after when the patient submits the form and PDF is created. The 'Send to PMS' option should be used only if for some reason the PDF file was not yet stored and is required right now.

Click here to learn more about Engagement Patient Card functionality.


Setup an Automatic Verification Rule

To set up an Automatic Verification Rule, you must have Admin privileges.

Take automated verification one step further with conveniently scheduled eligibility checks. To set up an automatic verification rule, follow the steps below.

  1. Navigate to the Eligibility tab in the Engagement left side menu

  2. To set up an automatic verification rule, click Automated verification setup in the upper left corner

  3. In the pop-up window, enter the number of days that you would like the rule to automatically check patient eligibility and then click Save

  4. The qualifications of your automation rule will show in the upper left header. Edit or remove the rule at any time by clicking Edit and then clicking Remove automation or Save


Batch Verify Incoming Patients

Important note: We use electronic payer IDs to verify eligibility. Electronic Payer IDs must be added to the Insurance Carrier list in your practice management software in order for patient insurance eligibility to be verified. If you are consistently noticing that a payer is not being included in your eligibility checks, please review the Carrier List in your practice management software and verify that the payer attached to the patient has the electronic ID associated with it.

Use the 'Verify All' Button

  1. Navigate to the Eligibility tab in the Engagement left side menu

  2. Click on the calendar button to select a date

  3. Click on the Verify All button in the upper right corner

'Verify All' will request an eligibility status on every patient for the selected day. Verification of the patients shown should only take a few seconds! While in progress, the patient status will show as Processing. When completed, your patient list will show updated eligibility statuses for each patient.

Use Bulk Actions

  1. Navigate to the Eligibility tab in the Engagement left side menu

  2. Filter the populated patient list based on patient eligibility status

  3. Select the Bulk Actions checkbox to select all patients from the filtered list

  4. Click on the Bulk Actions dropdown menu and then click Batch Verify

Verification of the selected patients should only take a few seconds! While in progress, the patient status will show as Processing. When completed, your patient list will show updated eligibility statuses for each patient.

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