SmartCare provides a process to verify a client’s insurance coverage eligibility for services. The verification can be with the coverage plan or a designated clearinghouse. This process is referred to as Electronic Eligibility Verification. There are two levels of Electronic Eligibility Verification.
Individual manual verification
Technically, both verifications use the standard 270/271 transfer files process. SmartCare creates a 270 file and sends the request to the coverage plan or clearinghouse to request the verification.
The coverage plan or clearinghouse creates the 271 file response that provides the information about the coverage that the client is currently eligible for. The 271 file provides the following information:
Description of coverage
Dates of eligibility for dates of service
Spenddown information, if applicable
Other information may be possible depending on the who is verifying the request
Additionally, the information in the 271 response file can be programmed to update SmartCare clients’ accounts automatically. Implementing the 270/271 process changes from state to state. However, once electronic eligibility is set up in a state, it is easier to set up another customer in the same state.
The Batch Eligibility files can be set up to run at any time and as often as you want. Typically, the batch files are set up to run overnight. If the process is too lengthy, the file can be broken into smaller batches and run on separate nights or times.
There are reports that are available that explain what information was updated or not.