Eligibility Tools & Resources
Verifying a patient’s eligibility is essential to determine coverage under a health insurance policy or MassHealth. The resources on this site include useful information and directions for providers and their office staff to confirm a patient’s eligibility for coverage.
It is important to check eligibility to:
• bill for services rendered
• determine copayments
• meet timely filing deadlines
• reduce claims rework
• make arrangements for financial assistance before an office visit
• improve office efficiency
Eligibility Verification Overview Tutorial
This audio visual presentation provides an overview of the eligibility verification process.
Eligibility Resource Guide
The document describes methods to check eligibility electronically,
including direct links to free payer websites and other methods for
checking eligibility, all summarized in one simple to use document.
A Guide to Member ID Cards
This document includes a sample insurance ID card and
explanations of common terminology.
This document provides tips to avoid common claim denials and rejections by
using eligibility verification.
Eligibility in the Revenue Cycle
This document details the benefits of verifying eligibility at different times during the revenue cycle.
A Guide to an Eligibility Response
This document contains a sample eligibility response screen outlining the content which may be provided by any given payer.
NEHEN Eligibility Best Practices
This document describes payer lessons learned for eligibility verification. For the entire NEHEN eligibility best practice manual go to:
http://www.nehen.org/resources/Eligibility Best Practices.pdf
The eligibility training materials and related information included on this
website were created by health plans and providers. HCAS provides access to the
eligibility training materials for educational purposes only and makes no
guarantees regarding their accuracy, completeness or compliance with health plan
requirements. Neither completion of eligibility training nor confirmation of
eligibility guarantees payment for services, and users of these training
materials must understand and agree that neither HCAS nor any of its
participating organizations are responsible or liable for any claim, loss, or
damage resulting from such use.