A lot of patients who will be eligible for Medicare Part D will not know any of their new insurance information, such as their new plans, Cardholder IDs, Group Numbers, etc.  But by doing an Eligibility Verification for the patient, you can obtain all of their new information and automatically add it into your system.  Here are the instructions for how you can do this.

1.    Go to the main screen of the pharmacy program.  If you look towards the top (above the options for New Rx, Edit, Refill, Display/Reprint Label and Price Check), you will see a bunch of tabs.  The fifth tab says Eligibility Verification.  Go to that tab.

2.    If the patient is already in the system, search for the patient and select them.  When you select the patient, all of their information will automatically be displayed in the boxes.  If the patient is not in your system, type in their name in LastName,FirstName format, and enter their Zip Code, Date of Birth and their Gender.

3.    After entering the Patient information, you must select a plan.  From the drop-down box, choose the insurance plan E1NDC.  This is the plan you need to use for the eligibility check and it has been automatically added into your system.

4.    For the Card ID you should enter ONE of the following:

a.  The patient’s Card ID from their Part A or Part B card.

b.  Last 4 digits of the patient’s Social Security Number.

c.  If neither of the first 2 are known, enter a default value of 999999999 or 9999.

5.    After entering in this information your screen should look similar to the picture below.  The essential fields you need to fill in are the Patient Name (in LastName,FirstName format), Zip Code, DOB, Gender, the Plan (must be E1NDC), and the Card ID.

6.   Once you have filled in all the necessary information, click the Transmit button.  Once you get the response, your screen will look something like the picture below.  This patient has 4 plans, and all of their information is displayed on the screen.

7. Once the information is displayed on the screen, you will see a button that says Update Patient Information.  Once you click on that button, the following things will happen.

a.       If any of the insurance plans shown are not already in your system (determined by BIN# and Proc Control#), the program will bring up a screen that will allow you to add those plans.

b.       The program will take you to the Patient File.

                                       i.      If this patient is not in your system, it will prompt you to add the patient.  The patient’s Name, Zip Code, DOB and Gender will already be displayed.  So will all the Insurance information returned from the Eligibility check.  Fill in the rest of the information and Save the patient.  MAKE SURE YOU SAVE THE PATIENT; otherwise the information will not get updated into your system.

                                     ii.      If the patient is already in the system, it will take you to the Insurance Plans tab of the Patient File and will display all the Insurance information returned from the Eligibility check.  If necessary, add any extra information that was not displayed automatically and Save the information.  MAKE SURE YOU SAVE THE INFORMATION; otherwise the information will not get updated into your system.

8. Now all the information has been updated into your system.  Click on the To Rx Processing button and you can now go ahead and process prescriptions for this patient.