Verifying Eligibility

patientNOW integrates with Optum for Real-Time Eligibility on the Patients | Registration / Billing, Insurance tab.

Some important notes:

1. The plan must be configured in patientNOW. If you are successfully sending claims to that plan, it is configured appropriately.
2. The patient's member number must be correct. The most common error is entering a "O" (Oh) instead of a "0" (zero) or vice-versa.
3. The plan must participate in Real-Time Eligibility with Optum; see Real-Time Eligibility List below.
4. You must complete any enrollment forms for eligibility (these are separate from the EMC agreements for claims); see Real-Time Eligibility List below.
5. You must upload completed enrollment forms and notify Optum that they are complete.

Optum Real-Time Eligibility List