Real-Time Eligibility Verification from a Patient's Chart


DrChrono allows you to verify eligibility and see what type of benefits your patient has under their insurance plan before you provide services.


To access the Real-Time Eligibility tool, you first need to open a patient's chart (Patients > Patient List > Chart ID or search directly for your patient's name).


In your patient's chart, select the Eligibility tab in the left-hand navigation pane.



Verifying Eligibility or Active Coverage

To verify that the patient has active coverage under their plan, ensure the patient's insurance information is loaded into their chart and click on the Run Primary Insurance or Run Secondary Insurance.  The system will ping the eligibility file provided by the payer and display eligibility and benefit information obtained from the file.


If the response is Cannot Process, it could be that the payer does not offer Real Time Eligibility Checks, the payer id is incorrect or missing or the patient id number is incorrect or missing.




Checking Benefit Level/Services Covered

To check benefits / services covered for a particular speciality, search for one or multiple from the drop down and then select Run Primary Insurance or Run Secondary Insurance.

If you don't select a specialty, the function will return benefits for any/all specialties listed on the eligibility and benefit file provided by the payer.




 Here you can view all the plan's coverage details with respect to the speciality you have selected.





Past Eligibility Checks

By selecting the Past Eligibility Checks tab, you can see eligibility checks that were previously run for the patient. You can filter by date of appointment, the date eligibility was checked, and sort by heading type. Failed eligibility checks are also recorded here.




Prescription Benefits

The DrChrono EHR also allows you to check your patient's insurance for prescription benefits. Prescription benefits can only be updated every 72 hours. To check prescription benefits, select the Check Prescription Benefit button.



Once you select Check Prescription Benefit, click on Benefit Summary to view the coverage information summary for prescriptions.




For additional information regarding:

Configuring Auto Eligibility click here

Checking eligibility for multiple specialties click here to see how Batch Eligibility works.



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