Eligibility Requests allow users in your clinic to contact a patient's insurer and verify that patient's insurance electronically through Fusion. This can save time by reducing the need to have to call the insurer. When a user sends an Eligibility Request through Fusion, the insurer will send a PDF back through Fusion with information about the patient's coverage for services. Eligibility Request results will display in the Eligibility Requests section of the patient chart. After an eligibility request has been returned, clinic staff will need to review the results and document the relevant information in the Verification section of the patient chart.
There are a few different ways to send Eligibility Requests within Fusion. If you are submitting a request for a single patient, you can send it from the Eligibility Requests section of the Patient Chart.
Send an Eligibility Request from the Patient Chart
- Open the Patient Chart.
- Click a Payer tab or scroll down to that Payer.
- Scroll down to the Eligibility Requests section for that Payer. (Each Payer tab will have an Eligibility Requests section).
- Click Send Request.
- Select or Enter the NPI you are sending the request under in the NPI field. (This will default to the clinic's default Reserve NPI. You can use the drop-down to select a different Reserve NPI, or enter another NPI in the field.)
- Enter the Date that the request should be effective as of in the Date field. (For example, the date of the patient's service.)
- Click the Send button.
- After you send the eligibility request, a record that an eligibility request was submitted will display in the Eligibility Requests section of the patient chart. This record will display the date the eligibility request was sent, the date it was received, and the status of the request.
When eligibility request results are available, the record displays with a Date Received and a Received Status. Click on a Received Request Record to see a PDF of the results.
Eligibility Request results vary from payer to payer. Results may include information such as:
- Coverage Information
- Deductible Information
- Co-Payment Information
- Service Information
Here is an example of the eligibility request results that a payer may return: