Overview
The Eligibility area is primarily used to create and send EDE Type 270 files to your Clearinghouse to verify client insurance eligibility. Once submitted, the Clearinghouse processes the 270 file and generates a response listing the submitted clients and indicating whether their insurance is still active. You will need to log in to your Clearinghouse website to view and interpret the results.
The Eligibility screen in PIMSY includes a variety of filtering options to help you target specific clients, insurances, or submission criteria, making it easy to manage and track eligibility verification.
Required Permissions and Prerequisites
- This article is in reference to our Desktop application
- Please assign the Create, Modify, View, and Delete permissions for the following rule(s):
- Client Eligibility
- Eligibility Electronic Verification
- Eligibility Electronic Posting (271 File)
- Electronic Data Exchange (submit)
Step-by-Step Instructions
Step 1: Navigating to the Eligibility Screen
From the top navigation menu, go to:
Financial > Eligibility Client
Step 2: Filtering Options
At the top of the Eligibility screen, you’ll find radio buttons that allow you to filter results based on Payer Priority:
- Primary
- Secondary
- Tertiary
The filter help streamline the process and ensure you’re targeting the correct records when generating and reviewing eligibility files. You can filter for clients with a specific insurance, or active only clients, or even as specific as individual clients by searching for client names.
To narrow down the displayed information even further, click the Filter button. This allows you to apply additional criteria to refine your results before generating the eligibility file.
Step 3: Generating an EDE file
Once you've applied your desired filters and have the appropriate client information displayed, you can generate an EDE 270 file directly from the Eligibility screen to send to your clearinghouse. To do this, simply select “270-***” from the EDE Type dropdown menu.
A message will appear asking if you wish to continue. Select Yes to generate the EDE file.
Once the 270 file has been generated, click Submit to send it to the clearinghouse for processing.
Additional Information
Users can also filter by appointment date ranges to limit the eligibility check to clients with upcoming or specific past appointments