Real Time Eligibility (RTE)

Role Required: Practice Scheduler, Practice Biller, or Biller for Assigned Patients Only

Real time eligibility (also known as RTE) allows practices to check insurance eligibility and benefits for existing or prospective clients right within TherapyNotes.

TherapyNotes will generate an eligibility verification request to check a client's insurance eligibility based on the information you’ve entered and send to the payer through our clearinghouse, CLAIM.MD. Each eligibility verification request costs just $0.14.

To enable real time eligibility verification:

Note: You must have the role of Practice Administrator, Clinical Administrator, or Practice Biller to enable this feature.

Click the User Icon > Settings > Practice Billing
Select the Enable Real Time Eligibility Verification checkbox.
Click the Save Billing Settings button.

Submitting Eligibility Verification Requests

Before submitting an eligibility verification request:

Ensure that your practice is enrolled in RTE with a payer before checking insurance eligibility for any client assigned to that payer. To verify this, click Payers > Payer name and under Clearinghouse Services, check that RTE has a green check mark next to it. See [Enroll to Submit Eligibility Verification] for more information.
Verify that the client's First Name, Last Name, and Date of Birth are entered on the Info tab of their chart.
Verify that the client has an eligible Payer selected for their Primary Insurance or Secondary Insurance on the Billing Settings tab of their chart.

To submit an eligibility verification request:

Click Patients > Patient name > Billing Settings tab
Under Primary Insurance or Secondary Insurance, click the Verify Eligibility button.
In the Verify Insurance Eligibility dialog that appears, select a clinician (Type 1) or practice location (Type II) from the Provider dropdown. Eligibility verification requests can only be submitted by or on behalf of providers with valid NPIs.
- Note: For payers requiring enrollment, the enrollment process can only be completed for the main practice location (Type II) at this time. As a result, once enrolled, “Main Office” will be the only option for Provider for these payers.
Enter the date to check the client's coverage for in the Date of Coverage field.
Click the Submit Request button.

It may take up to two minutes to receive your eligibility verification report, but you'll receive most reports within a few seconds. When you receive a new report, a New report available link will appear next to the Eligibility field in the client's Primary Insurance or Secondary Insurance information on their Billing Settings tab. A Review eligibility verification reports link will also appear on your To-Do list when there are new reports ready.

Viewing Eligibility Verification Reports

New eligibility verification reports can be accessed by

Clicking the New report available link on the client's Billing Settings tab for the given policy
Clicking the Review eligibility verification reports link on your To-Do list
Clicking the Eligibility History link on the client or practice Billing tab

If you've previously verified eligibility for a client, the date and time of their last check will appear in the Eligibility field of the Insurance section on their Billing Settings tab. Click the Last checked link to view the Eligibility Verification History for the client, which includes all of their previous eligibility reports.

All previous reports submitted for any of your assigned clients can be found on the Eligibility Verification History page by visiting Billing > Eligibility History. On the Eligibility Verification History page, use the filters to find the desired transaction and click the Transaction # or Status to view the corresponding report.

Each eligibility verification report contains details about the eligibility verification request that you submitted as well as any information TherapyNotes receives from the payer, including Provider Information, Subscriber and Dependent Information, Eligibility and Benefit Information, and any associated benefit details. After you have reviewed, click the Mark as Reviewed button in upper right corner of the report.