Open enrollment season is drawing closer, giving patients their annual opportunity to switch payer plans. For vendors who service healthcare providers, it’s a time that reinforces the importance of building efficient, accurate and flexible tools for confirming patient eligibility.
Prior to the new year, providers may simply need to answer patient inquiries about whether they participate in certain plans. But after January 1, accurate eligibility verification becomes key to ensuring prompt reimbursements.
“By January, a lot of people have changed insurance,” one admissions coordinator told ABILITY. “We don’t learn about it until after the fact. We ask our patients and their families to talk to us if they decide to change insurance, but unless someone goes in and checks eligibility, we might not know the patient is no longer eligible.”
This comment highlights providers’ needs for eligibility verification tools that can help them tackle the challenges following open enrollment season. Depending on the provider’s line of business, they may need tools that can help with:
- One-time eligibility checks
- Batch eligibility checking capabilities
- Automatic recurring verification
- Alerts when a patient’s status changes
At ABILITY, we offer our Strategic Partners the technology to provide the above tools in a variety of ways:
- ABILITY | ACCESS® Medicare Eligibility and ABILITY | ACCESS® All-Payer Eligibility provide several platforms for connecting to the HIPAA Eligibility Transaction System (HETS) or other payers for real-time or batch eligibility (270/271) transactions in native X12 EDI standards or parameterized and XML formats
- ABILITY | ACCESS® DDE API and ABILITY | ACCESS® DDE API+ are REST-based API toolkits providing a complete programmatic DDE data retrieval system (DDE API) or a data-write system (DDE API+). These toolkits double as REST-based APIs for real-time Medicare and all-payer eligibility (270/271) transactions in both native X12, parameterized, and XML formats
With these capabilities and your own expertise about your customers’ unique needs for eligibility verification, you hold the keys to making your product stickier for existing customers, as well as attracting new customers.
To learn more about how our eligibility services can help you boost your sales and customer loyalty, call us today at 888.271.8222, or email firstname.lastname@example.org.
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