Overview

Eligibility refers to a patient’s qualification to receive specific medical benefits, services, or coverage under their health plan.

Stedi allows you to reliably determine patient eligibility, even when the patient doesn’t know or can’t provide accurate insurance information. Once you integrate with Stedi, you can use the UI tools in Eligibility Manager to test, troubleshoot, and monitor your entire eligibility pipeline.

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Eligibility workflows

Here’s an overview of the eligibility workflows you can automate with Stedi’s APIs:

• Eligibility checks: Verify a patient’s coverage with a specific payer. Eligibility checks return full benefits information from the payer, so they’re helpful when you need to determine a patient’s financial responsibilities for medical services, such as co-payments, deductibles, and out-of-pocket maximums.
• Insurance discovery: Find a patient’s active health plans using their demographic information, such as their name and date of birth. Insurance discovery checks return the same benefits information as a standard eligibility check, making them a great alternative to eligibility checks when patients can’t provide accurate insurance information.
• Coordination of benefits: Determine whether a patient has multiple, overlapping coverages and if so, which plan is primarily responsible for payment (primacy). COB checks help you submit claims to the correct payer and avoid claim denials.

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Eligibility Manager

Eligibility Manager helps you track and manage your entire eligibility pipeline. It provides a centralized view of all your eligibility checks, including real-time and batch requests, and helps you efficiently troubleshoot issues and review patient coverage details.

Within Eligibility Manager, you can also manually submit new eligibility checks and coordination of benefits checks as needed.