Insurance eligibility check

Each row is a verification request sent to a payer (via the ClaimMD clearinghouse) to confirm a patient’s insurance coverage, along with its result. Join to patient and patient_insurance for the patient and the policy that were checked. This table’s columns and relationships are shown in the Hosted Database schema.

is_eligible is the payer’s determination for the check (true = active/eligible coverage, false = inactive) - it is the source of the eligibility status carried on patient_insurance. is_internal marks checks initiated by an internal Elation pathway (EHR insurance sync or agentic billing) rather than by a billing user.

For reporting on but not limited to:

Whether a patient’s coverage came back eligible, and when it was last checked
Eligibility check volume and outcomes over time
How checks were run (electronic, manual, or error)
Which checks were internal/automated versus user-initiated

Recent eligibility results for a patient

select
    e.date_of_service
  , p.full_name
  , pi.carrier
  , e.is_eligible
  , e.type
from insurance_eligibility_check e
  left join patient p on p.id = e.patient_id
  left join patient_insurance pi on pi.id = e.patient_insurance_id
where e.date_of_service >= dateadd(month, -3, current_date())
  and not e.is_deleted
order by e.date_of_service desc;

If you have any questions about this topic please reach out to Elation Support Portal with the subject line HDB - <your_question>

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Elation Billing

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Recent eligibility results for a patient

​Recent eligibility results for a patient

Recent eligibility results for a patient