Real Time Eligibility
Welcome to the GoRev Real Time Eligibility Tutorial. In this tutorial, we will focus on the process of utilizing the Eligibility Module in GoRev.
1 : Navigating to the Patient Overview Module
As a GoRev User, the Eligibility Module will allow you to determine a Patient’s Insurance Eligibility in Real Time. To begin, please navigate to the Patient Overview Module of the required Patient by using the Search area on the GoRev Homepage.
2 : Navigating to the GoRev Eligibility Module
At this point, the Patient Overview Module for the required Patient will appear on your screen. Now, in order to determine the Patient’s Insurance Eligibility in Real Time, begin by clicking on the “Eligibility” button located in the Office section of the Patient Overview Toolbar.
Note: Please ensure that you have entered the patient's insurance information into the insurance section of the patients overview window. This information will be required in order to run an eligibility request.
3 : Utilizing the CIGM Information Section
The Electronic Eligibility request window should now be present on your screen. In this window, you will have the ability to view the patients CIGM information in the uppermost portion of this screen.
In addition to the CIGM section of this window, you will also have the ability to open the insurance group management window in order to upload Insurance files, edit insurance information, view patient files, and publish the content altered within this window. To continue, please click on the CIGM button in order to open the Insurance Group Management Window.
At this point, you will have the ability to edit the patients group information, plan administrator, and notes by typing into the provided fields. Once finished editing, click the save changes button present in the top left corner of this window.
4 : Analyzing the "Find Coverage" Window
The "Find Coverage" module can be utilized to discover insurance coverage for patients where you may not have obtained any coverage at the time of service. GoRev now supports an integration with WaveHDC to support automated insurance discovery. To begin, please click on the Find Coverage button present on your screen.
Note: If you would like to learn more about setting up this feature, please visit our GoRev Integration with WaveHDC guide.
At this point, a pop up will appear on your screen. Please click on the yes button to continue searching for active insurance coverage.
Finally, the "Found Coverages" screen should be visible on your device. From this window, you will be able to review and select any insurance coverages found for the patient. If the patient is covered by multiple plans, each section will be labeled as Primary, Secondary, Tertiary, or Other to clearly distinguish the information. Please begin by reviewing the information within each section.
Then, select the "Apply to Patient Encounter" option to select the insurance plan for any insurance plans you wish to add to the patient's chart.
Once finished, click on the "Apply Selection(s)" button to complete this process or simply close the window if you do not wish to apply any of the insurance plans to the patient's chart.
5 : Navigating to the "Eligibility Request" Window
To begin running an eligibility request, please click on the “Real Time Eligibility” button present on your device.
6 : Analyzing the "Subscriber Information" Section
At this point, the “Electronic Eligibility Request” window will appear on your screen. The “Electronic Eligibility Request” window is comprised of four sections. In the first section, titled “Subscriber Information”, you will find the appropriate Guarantor Information for this Patient Account.
7 : Locating the "Insurance Information" Section
In addition to the “Subscriber Information” section, the “Electronic Eligibility Request” window, also, contains a secondary section, titled “Insurance Information”. In this section, you will find the “GoRev Carrier”, the “Clearinghouse Payer”, the Patient’s “Member ID”, and the “Group Number”.
8 : Defining the "Clearinghouse Payer"
As a default, the “Clearinghouse Payer” field will be auto-filled. However, if this field is blank, please enter the Clearinghouse Payer for this Patient Account. To correct this field, please search for the required Clearinghouse Payer by entering the Payer’s Name or ID into the corresponding field provided.
Note: As you are entering this information, existing Clearinghouse Payers will appear below the field that you are filling. Once you locate the correct Clearinghouse Payer, please use the arrow keys to highlight this Payer and hit “Enter” on your keyboard.
9 : Analyzing the "Patient Information" Section
In addition to the “Insurance Information” section, the “Electronic Eligibility Request” window, also, contains a third section, titled “Patient Information”. In this section, you will find the Patient’s Name, Social Security Number, and their Relationship to the Insured.
Note: The Patient information fields will contain the patient's information in any instance where the patient is not the subscriber. This will be denoted by the "subscriber is patient" checkbox within the right corner of this section.
10 : Analyzing the Additional "Insurance Information" Section
Lastly, the “Electronic Eligibility Request” window contains a fourth section, which is, also, titled “Insurance Information”. In this section, you will find the Patient’s “Date of Service”, the “Visit Location”, and the appropriate “Procedure Codes” for this Visit.
11 : Including Procedure Codes in the Eligibility Request
If you would like to include CPT Codes in your Eligibility Request, please enter the appropriate CPT Code into the “Procedure Codes” field in this section.
Additionally, you will have the ability to enter multiple CPT Codes for this Patient by separating each CPT Code with a comma.
12 : Submitting the Eligibility Request
Now, in order to submit the Eligibility Request, please click on the “Run Eligibility” button present in the bottom right corner of this window.
Note: Once you select the run eligibility button, an eligibility response will automatically be uploaded into the patients file management section for both inactive and active insurance plans.
13 : Responding to an "Operation Failed" Window
In the event that an “Operation Failed” window appears on your device, please read the error description present in this window and correct any errors pertaining to the Patient’s Account.
If you are unable to correct an error, please submit an IT Support Ticket by using the “Submit Ticket” button in this window.
14 : Analyzing an Inactive Status Result
At this point, the Results of the Eligibility Request will be present on your screen. Eligibility Requests result in an Active, Request Rejected or an Inactive Status. An Eligibility Request will result in an Inactive Status if the Patient’s Insurance Coverage was identified but is Not Active for the specified Date of Service. As a default, an Inactive Status will cause the GoRev Eligibility Status field to appear red.
15 : Viewing the Detailed Eligibility Status Response for the Inactive Status Result
Now, in order to view a more detailed Eligibility Status Response, please click on the “Eligibility Response” link in this window.
16 : Reviewing the Eligibility Response Window
At this point, the detailed Eligibility Response will open in your computer’s default web browser. This window will provide you with the opportunity to further Review and Utilize the coverage information provided for the patient.
17 : Saving the Response to the File Management System
After the window has closed, you will have the ability to edit the fields present within the GoRev Eligibility window. Once finished, please click on the “Save Changes” button present near the bottom of the “GoRev Eligibility” window.
18 : Analyzing an Active Status Result
In opposition to an Inactive Status, an Eligibility Request will result in an Active Status if the Patient’s Insurance Coverage was identified and is Active for the specified Date of Service. As a default, an Active Status will cause the GoRev Eligibility Status field to appear green.
Additionally, if the Patient’s Insurance Coverage is Active, the fields in the “Patient Responsibilities and Deductible” section of this window will be auto-filled.
19 : Viewing the Detailed Eligibility Status Response for the Active Status Result
Now, if you would like to view a more detailed Eligibility Status Response, please use the “Eligibility Response” link on your screen to complete this task.
20 : Saving the Eligibility Request Response
Furthermore, if you would like to Save any information entered into the Eligibility Request Response window, please use the “Save Changes” button in this window to save the entered information.
21 : Reviewing a Rejected Eligibility Request
Lastly, an eligibility request will result in a "Request Rejected" response for several reasons. One common cause of eligibility failure is frequent system maintenance performed by the insurance provider. Additionally, this response may occur if the clearinghouse is temporarily unable to process the inquiry. In these instances, it is often recommended to contact the insurance provider directly, consult with your clearinghouse for further information, or wait and resubmit the eligibility request again at a later time.
Additional Resources
GoRev Support Team
If you have any questions, concerns, or problems regarding this GoRev Tutorial, please contact the GoRev Support Team by submitting an IT Support Ticket, by phone at 1-(317)-794-3900, and/or by email at ask@gorev.com.
Note: Always submit an IT Support Ticket detailing the problem that you are experiencing with this portion of GoRev, if possible, as this will give GoRev Support Agents access to information that will help expedite the resolution of your issue. If you are unsure how to submit an IT Support Ticket in GoRev, please see the IT Support Ticket Creation tutorial for assistance.
