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

Resource Materials

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.

Helpful Hints
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

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.