Tyson Edwards #2, side by side pop up showing difference and you choose what you want.

Tyson Edwards -1 or 2!

Tyson Edwards Ideally #2, love the idea of a side by side pop up showing difference

Tyson Edwards #2!

Tyson Edwards I agree with Sara - #2 so we can see the changes. And an alert so we know there has been a change.

Tyson Edwards 2

Tyson Edwards #2....seeing what is different and being able to choose whether or not to accept

BRIAN STONE What would be the reason you would not accept it?

Tyson Edwards For example, what benefits is the system going to pull....general medical benefits or specifically mental health benefits? Depending on the benefits verified, a pt can have different copays, etc. If the system verifies a pt's insurance using general medical benefits which shows a $20 copay but I know that for mental health, the insurance considers me a specialist and the pt should have a $50 copay, then I would not want to accept the verification pulled by the system. The reverse could also be true. The system could pull mental health benefits with a $50 copay but I know the insurance allows me to only charge the $20 copay as if they were at a PCP visit, then I also would not want to accept the verification.

BRIAN STONE: Understood, so for us, you'd be able to set the service code by service so when checking the eligibility from the Appt Popup, we would know the PQ service and defined service code for that service so we would pass that through.

If you are checking from the Client Profile, you'd be able to choose the service code you want to check for.

Would this reduce the likelyhood of not wanting to accept the info into the chart?

Tyson Edwards that would certainly make things easier if we can select the benefits we are wanting to check

Tyson Edwards #2 display and highlight what has changed

Sara Ruckenbrod So you'd want the granularity to choose which fields update? Copay but not Coinsurance etc? Or could we just say 'Accept All" or "Accept None"?

Tyson EdwardsI think to be applicable to all types of settings have a way to accept individual items, but the accept all or none option as well would be nice

Tyson Edwards I would select option 2. Thank you for your hard work! I've read through the comments and this is going to be a great feature!!

Tyson Edwards You would need to be able to use the CPT code and diagnosis, as some insurances change the rules based on diagnosis.

Option 2 is still best because if there are changes we're going to need to know what they are in case it impacts other things in our system.

Tyson Edwards 2....Maybe I've missed something but is there an effective date option to select on the section where the insurance is entered?

Tyson Edwards Display what has changed before accepting the new insurance information it into the profile

Tyson Edwards I vote a way to see the changes with a prompt to accept the changes, but also a history of changes made so we can always go back and see what is was and what is it now. Kind of like an "events" list

Tyson Edwards#2

Tyson Edwards Can we decide per company between these options over time? Ideally I like the option of #1 but honestly we've had such a varied experience with eligibility checks that I would want #2 until I trust the system is giving me accurate results, then I would definitely want #1.

Tyson Edwards Hi Tyson! Do you have an ETA as to when this new product feature would be available? TIA and appreciate all of the hard work you put into these improvements/updates!

Tyson Edwards status update?

Tyson Edwards Would this be able to check out of network benefits? As an out of network clinic, we don't process insurance claims, but we do check eligibility now using reimbursify. Will we be able to eliminate that service? And use IQ?

Tyson Edwards - That would be perfect for us. But, depending on the specialty, it may be wise to add a section for the POS and Modifier to go along with the CPT code. It will definitely affect the outcome of benefits provided. Great job! Thank you so much!

Tyson Edwards yes, we use multiple codes and some will have cost sharing and some won't

Tyson Edwards What about something like this?

VERIFY BENEFITS (action button), with automatically read-in inputs from Client Profile (name, insurance ID, date of birth, etc), plus three fields that have to be hand entered with each benefits check:

Another option might be to have an Eligibility Check Defaults interface, similar to the existing Claims Details, in which we could enter a specific CPT code that we'd commonly want to run the check for, and then the VERIFY BENEFITS script would, for example, automatically assume a "today" date range. That would make it easier. But my head starts to spin when I think about how to get that to work with batch eligibility checks.

Below is a screenshot from Oregon Health Authority's eligibility check for Medicaid members interface, as an example. You don't need the SSN unless you don't know the Client ID (i.e. insurance id number), but you do need to specify all of the other information.

THANK YOU SO MUCH for working on this by the way. This is such a valuable feature to integration into PQ. Very much appreciated, y'all are the best.

Tyson Edwards Also, looking at another EHR might be helpful, for example, Therapy Appointments... https://support.therapyappointment.com/article/593-insurance-eligibility-verification

Tyson Edwards for our practice and how its worked with other EHR systems we have used - we simply want it to run a batch daily to verify that the patient insurance is active and catch inactive/terminated policies. We would not use this related co-pays etc.

Tyson Edwards I agree with Tammy and Annie below... it varies by service and type of situation whether you want to "Just" check eligibility or check a specific type/POS/modifier combo. I like having the option to put those in, as well as a general option where you can check "general" eligibility and benefits. One thing is that benefit checks will vary greatly by service so some services like ours (nutrition) often don't have specific benefits simply due to the insurance company not specifying those in detail. I would LOVE for that to be different, but currently there's just very wide availability on what's possible.

Christopher Brehm thanks for sharing this example. I’m from Oregon too. I also agree these folks rock! I’ve been with IQ since a year or two before the pandemic and seen the evolution and expansion of services. I’m glad to see them grow their customer base. I’m also looking forward to this new feature.

Tyson Edwards that is amazing!!

Tyson Edwards from questionnaires would be a cool feature! We read thru them and get insurance info here to check in kareo now - so we would check it from here all the time! Or from the client profile homepage where insurance is shown.

Thank you so much for this! I’m ready to stop using multiple systems to check eligibility, bill and track those payments - all outside of IQ and it’s a pain!

Kirsten MacArthur I was thinking it would be nice if from the intake, it automatically checks the insurance elig if the client fill out all the necessary info and then you’ll be able to view the eligibility when reviewing the intake w/o having to manually check. Would this be helpful?

Tyson Edwards wow that would be amazing! 🤩

Kirsten MacArthur so in that case, it would check it at the date of intake. But you would need to check it on the date of the appointment right? Would you want it at both times?

Tyson Edwards both times would be even better!

Tyson Edwards yes both times please

Tyson Edwards - Would this require the patient to select the correct insurance company from a list that included the payer ID? (Rather than just typing a name)

Tyson Edwardsthis would be a dream come true

Tyson Edwards will the check pull relevant info like copay & deductible?

Steve H Hmm yeas, maybe we could just display your payer list that they could select from. I guess we would need an option for OON too.

Annie Frisbie Yes

Tyson Edwards maybe "Payer not listed" and a space for them to manually enter. Sometimes there are subsidiaries that we don't know about yet

instead of OON

Tyson Edwards The more we can do to catch lapses in coverage sooner, the better. I would also like it if the benefits checks would flag an alert for the biller & admin to make sure these things are properly attended to if there is a problem or a change is noted.

Tyson Edwards Is this for everyone - or only the people that come over to the new clearinghouse once it is up and running?

Tyson Edwards - Hi Tyson! Would this also give us the ability to provide specific benefits for the specialty we are in? Such as mental health outpatient provider via telehealth or office? And also include deductible, deductible amounts met, coinsurance, out of pocket and accumulations. Family therapy, individual, group, claims billing address, effective and end dates?

Tyson Edwards I am not sure I would want the logic of checking insurance during the booking questionnaire. It adds logic that can fail. I want the booking process to be simple and free from errors. As a consumer, I will dump a website very quickly if I get an error. I would however, like the ability for ME to press a button and check when I receive the request.