From the Eligibility module, users are able to verify a member’s eligibility and report any discrepancies.

VERIFYING ELIGIBILITY

Step 1: From the Eligibility list, select Member Verification.

Step 2: The screen will display as shown below.

Step 3: Users can search for members in two different ways:

Search by entering the Member ID for the specific person.

Search by entering the Last Name, Date of Birth, and Gender of the member; all three fields must be completed.

Step 4: Select Verify Eligibility. If the member exists in the system, their details will be displayed as shown below.

Note: Users can skip this search criteria if they want to generate EOBs for multiple members from an organization.

Step 4: Enter the correct organization name or search the organization by clicking the magnifying glass icon. The Organization Search screen will be displayed as below. Only organizations that users are affiliated with will show in the search screen.

To view additional details about the member’s eligibility, click the magnifying glass (first icon) under Details.

To print the member’s eligibility, click the Print button (second icon) under Details.