The eligibility module enables healthcare providers to check the eligibility or the insurance coverage of the beneficiary. This module confirms to the healthcare providers that whether patient is eligible or out of network.
To perform Request Eligibility Transaction, you need to follow below mentioned steps: -
Step 1: : login to https://eclaims.waseel.com/en/
Step 2 : from left side menu click on Eligibility -> Request Eligibility .
Step 2: Search the Beneficiary, enter minimum four characters to retrieve existing beneficiary information.
Note: Create a new beneficiary, if the beneficiary does not exist in the system.
Step 3: Select the desired beneficiary, it will automatically fill all the basic information required to perform eligibility transaction. It includes
- Beneficiary Name
- Service Date: By default, it will display current date
- Insurance Plan: It will retrieve the beneficiary coverage detail from beneficiary insurance section; however, if insurance information doesn’t exist then the drop down will remain empty.
Step 4: Choose the Eligibility Purpose which can be anyone out of following: -
- Benefits: Choosing this purpose will display details of the insurance coverage or benefits
- Validation: Choosing this purpose is to validate the eligibility within the Provider’s network
- Discovery: Choosing this purpose means to discover beneficiary insurance plan with a particular Payer. This option is suitable when a patient does not know the insurance plan details.
- Note: Submitting an eligibility request by choosing Discovery purpose, automatically fill the insurance section under beneficiary details.
Step 5: Click on “Request Eligibility “button”. This step submit eligibility the request and receive the response in real time from payer via NPHIES platform.