Verifying Eligibility

The eligibility status for clients can be verified on demand and instantly by clicking the "Verify" or "Verify Selected" buttons on the Contact, Client, and Client Payer pages. You can mass verify more than one client payer using the Client Payers report. Since there is a $0.12 charge for every instant client and payer eligibility verification, being able to verify eligibility is restricted to administrators and users with the "Verify Client" permission. For example, if you run the Client Payer report, select 10 rows, and click the Verify Selected buttons then $1.20 will be added to your next invoice.

The system never verifies the eligibility status for some payer sources like self pay and pro bono. Most other payers are supported but some are not, and there is no charge if the payer is not supported. Specifically Medicaid, Medicare, and the three Oklahoma MCO payers are supported. You can check ahead of time if a payer is supported by going here.

It is not recommended to verify OKHCA payers because the system automatically verifies the eligibility status for OKHCA payer sources three times a month with a separate batch process. In addition the "Payer Comment" for each client is update every night for OKHCA payer sources (and change notifications sent) even though the eligibility is not updated. This over night process will also expire ineligible Oklahoma MCO payers listed for the client as long as OK Medicaid or OK ODMHSAS is listed as an active payer for the client.