Intellect™
BILLING MENU OPTIONS
Tele Com
Eligibility
Eligibility Add
Updates:
Effective version 21.04.14
New Inovalon/Ability All Ease Payer integration for Eligibility Verification is now available.
Prime Clinical Systems developed another API solution for the Eligibility Verification for the Inovalon/Ability All Ease Payer Solution to function the same as the current method of OnStaff/Intellect Eligibility Verification. Contact PCS for details.
Announcement in version 18.03.14 release note:
Eligibility TLS/TPS Changes for Cognizant/TriZetto Clients
New requirements have been assigned by Cognizant/TriZetto for TLS in using the ELIGIBILITY features in the Intellect software. Cognizant stated, "In an effort to enhance our current product functionality and capabilities, we are in the process of upgrading your Master Eligibility Web Service (MES) offering. TPS will disable TLS 1.0 security protocol by end of year 2018, and is requesting clients upgrade their systems to accommodate TLS 1.1 and/or 1.2 protocols prior to this date." (emphasis added). In response to Cognizant's changes, Prime Clinical Systems has made the necessary changes to our software to comply with Cognizant/TriZetto's product. If offices that use Cognizant/TriZetto as their Clearing House Solution, require an Intellect update to a version date greater than 2/28/2018. This change is seamless and requires no action on the part of the office once the software is updated. Failure to update to an Intellect version date greater than 2/28/2018 prior to December 2018 results in a non-functioning Eligibility feature within Intellect.
This menu option is used to add Insurance billing eligibility records for patients' accounts. When a client's billing is set for Tele Com for an approved Verification vendor, this screen populates with Verification Requests that have been sent via Billing --►Tele Com --►Verify (270) and picked-up by Billing --►Tele Com --►Acknowledgement (271). Use this screen to manually add specific patient accounts to the file.
1. To add eligibility records in Intellect, go to Billing --►Tele Com --► Eligibility --►Add
The Add Eligibility screen displays:
2. Date 
2.1 The field defaults to the current calendar date.
2.2 This is a read-only field and may not be modified.
3.1 Type the patient account number whose eligibility status is to be added.
- OR -
3.2 Type up to 6 characters of the last name and press the [F2] key. The use of the wild card character (*) helps when only part of a name is known. Intellect displays a Searching box with the focus in the Account Column. To select the account from the list, either highlight the record and press [Enter], OR double-click on the record to fill the Add Eligibility screen and move the focus to the <Insurance Name> field -- see sample below. For more information on the Searching feature, see Introduction To Intellect --► Intellect Characteristics and Features - Searching.
3.3 This field is mandatory. If this field is left blank and [Enter] is pressed, this message displays:
4. Name 
4.1 The associated name is displayed from the entered account number: Last, First.
4.2 This is a read-only field and may not be modified.
5. SSN 
5.1 The patient's social security number displays based on the <Social Security No> field on the Registration --► Regular --►Patient screen.
Effective version 16.12.02, options of masking the SSN (displaying only the last 4 digits) or not masking the SSN were added. For additional information, see Utility --►Set Up --►Screen Fields, Masking/Unmasking the Social Security Number (SSN).
Effective version 16.11.10, the SSN only displays the very last 4 digits and the rest are represented with asterisks (***-**-1234), unless the data in the database is malformed or incomplete.
5.2 This is a read-only field and may not be modified.
6. DOB 
6.1 The patient's date of birth displays based on the Registration --►Regular --►Patient <DOB> field.
6.2 This is a read-only field and may not be modified.
7. User No. 
7.1 The Utility --►Set Up --►Security --►Log In Users <User Number> for the current operator.
7.2 This is a read-only field and may not be modified.
8. Primary Ins 
8.1 The primary insurance company name displays based on the Registration --►Regular --►Patient Insurance <Insurance Company Name> field.
8.2 This is a read-only field and may not be modified.
9. Subscriber No 
9.1 The subscriber number displays based on the Registration --►Regular --►Patient Insurance <Subscriber No> field for the primary insurer.
9.2 This is a read-only field and may not be modified.
10. Group 
10.1 The group number displays based on the Registration --►Regular --►Patient Insurance <Group No> field for the primary insurer.
10.2 This is a read-only field and may not be modified.
11. Cov From 
11.1 The coverage begin date displays based on the Registration --►Regular --►Patient Insurance <Coverage From> field for the primary insurer.
11.2 This is a read-only field and may not be modified.
12. Cov To 
12.1 The coverage end date displays based on the Registration --►Regular --►Patient Insurance <Coverage To> field for the primary insurer.
12.2 This is a read-only field and may not be modified.
13. Deduct 
13.1 Intellect displays the <Deductible Met> info from the Registration --►Regular --►Patient Insurance screen.
13.2 This is a read-only field and may not be modified.
14. Copay 
14.1 Intellect displays the <Co Payment> info from the Registration --►Regular --►Patient Insurance screen.
14.2 This is a read-only field and may not be modified.
15. Sec Ins 
15.1 The secondary insurance company name displays based on the Registration --►Regular --►Patient Insurance <Insurance Company Name> field.
15.2 This is a read-only field and may not be modified.
16. Subscriber No 
16.1 The subscriber number displays based on the Registration --►Regular --►Patient Insurance <Subscriber No> field for the secondary insurer.
17. Group 
17.1 The group number displays based on the Registration --►Regular --►Patient Insurance <Group No> field for the secondary insurer.
17.2 This is a read-only field and may not be modified.
18. Insurance Name 
18.1 Type the name for the insurer for this record.
19. Subscriber Name 
19.1 Type the subscriber name for this payer.
20. Subscriber No 
20.1 Enter the subscriber number for this patient for this payer.
21. Cov Verified For DOS 
21.1 Enter the patient’s scheduled date for this record.
22. Dependent Elig From 
22.1 Enter the date the dependent became eligible.
23. Dependent Elig To 
23.1 Enter the date the eligibility of the dependent ends.
After pressing the [Enter], [Tab], or ↓ (down) arrows, the focus moves to the Command Column.
24. C (Command Column) 
24.1 With the focus in the Command Column, press [F2] to see these choices:
24.2 Only the <Amount> and the <Remark> columns may be modified.
25. Message 
25.1 Displays the line item description from the payer. For user-added verifications, this field is always blank.
Note: Prior to version 9.12.13, Response Code AAA67, used by the insurance when the patient was not found in their eligibility records, was not programmed in Intellect. Therefore, nothing would show in Intellect's Eligibility History. Effective version 9.12.13, the 271 Response Code AAA67 was added to the eligibility verification programming, allowing the code to be inserted into the patient's Intellect eligibility record and the description to be displayed in the patient eligibility history.
26.1 Displays the line item description.
27.1 Displays the line item clarification or notation.
Note: Prior to version 9.12.13, Response Code AAA67, used by the insurance when the patient was not found in their eligibility records, was not programmed in Intellect. Therefore, nothing would show in Intellect's Eligibility History. Effective version 9.12.13, the 271 Response Code AAA67 was added to the eligibility verification programming, allowing the code to be inserted into the patient's Intellect eligibility record and the description to be displayed in the patient eligibility history.
28. When the information is completely entered, select one of these options:
28.1 Click [Add] to commit any new records and clear the screen, returning the focus to the <ACN> (patient account number) field.
28.2 Click [Exit] to exit without saving, returning to the main Intellect screen.
User-created records may be seen in Eligibility Modify, Eligibility View, and on the Printed Eligibility Report.
