Pediatric Eligability Form

[rlopez32]

Hello everyone

I am helping a pediatric office get a flowing procedure in regards to checking eligability for newborns and infants, I was wondering if anyone has or has seen a good pediatric eligability form. Something that has the important questions to ask ins. companies regarding eligability. I know I can make one, but was hoping someone had one that works really well. Thanks!

[PMRNC]

I give my clients a screening form which they basically go over with the patient right on the phone when they are scheduling the appt, then it gets faxed over to me for eligibility.
The form will include the general info needed on the insured, patient, dob, insured's info, any other insurances, etc..(all of that is collected by the person scheduling the appt)   The next area will be the part I do when verifying benefits.  With Ped's it's just standard, you want to ask if there is well-child care, immunizations, coinsurance/co-pay, max, lifetime max, any dollar limits.. the usual. I also ask if per-certification is required. I also like to get the policy effective date, verify there is no other insurance on file for dependents and make sure insured has dependent covered.  Pretty straight forward and you can do all this in MS word doc. 

[rdmoore2003]

I agree with Linda.  My form is just an insurance tracking form.  I have the same information on my form.   Once I get the pt information including insurance, we call and get specifics.   Just remember to document the date you called, who you spoke with, and any other pertinent info of the customer service rep if you have to call back for any reason.

[PMRNC]

I agree with Linda.  My form is just an insurance tracking form.  I have the same information on my form.   Once I get the pt information including insurance, we call and get specifics.   Just remember to document the date you called, who you spoke with, and any other pertinent info of the customer service rep if you have to call back for any reason.

Yes good points.. on top portion that the office person uses to get the prescreening information I have them initial the form at top along with entering date and time, and then at bottom of the form, I also initial my part, date and get person's name I spoke with or attach copy of the fax/back or form from electronic eligibility. That usually puts a stop to any "he said she said"  Our patient's are always also read the same disclaimer the insurance company gives "this is just an estimate based on the eligibility and benefits at the time of service....etc etc etc"  Covers us if the insurance gives us eligibility and low-behold we later find out the policy terminated or COBRA payment wasn't received, etc.