Therabill has integrated Real Time Eligibility and Benefits Checks (E&B) from the Availity clearinghouse. In addition to eligibility, the E&B response from the insurance company that you will be billing electronically gives a variety of information about the patients coverage, such as deductibles (and where they are at in their deductible) and co-pay amounts. The E&B through the Availity clearinghouse is considered Real Time as opposed to Batch.
What is Real Time?
A real time eligibility & benefits check is much quicker. It queries the insurance companies server and a response is returned immediately (well, within 15 seconds). That is, you get the response in real time.
What is Batch?
When something is done in batch, a request is sent to the insurance company (immediately). However, the insurance company holds on to all files received and then responds to all requests during pre-determined date(s) and/or time(s). In this case, you may have to wait a while for your response.
Therabill went with Real Time
Therabill went with Real Time , initially, because we think this will be the way of the future. It is much nicer to get immediate responses. The problem is that not as many insurance companies are set up to do real time eligibility & benefits checks. We do believe that more and more insurance companies will be adopting this technology over time. But, right now, the list of insurance companies is limited.
Which insurance companies are available for Real Time
IMPORTANT UPDATE: Availity (the clearinghouse that Therabill has partnered with for Eligibility & Benefits) has recently switched to a paid model for using their service. Some of the payers that they offer, they have moved into their new Advanced Availity Clearinghouse. For these payers, they are requiring a monthly charge for access. Therabill will need to remove these from our free offering of real time eligibility and benefits checks. If you have your own Availity Advanced Clearinghouse account and you would like Therabill to connect to your Availity account, please send an e-mail to Therabill using the Contact Us form while logged in to your Therabill account to let us know.
There are only a hand full of insurance companies that are offered for real time eligibility and benefits checks through Availity. We have seen this list grow slowly. We hope the list will grow quicker after large development requirements that the insurance companies are under such as the 5010 conversion and more recently the transition to ICD-10. Below is a list of currently available insurance companies.
- Avmed, Inc (Payer ID 59274)
- Blue Cross Blue Shield of Florida (Payer ID 00590)
- Blue Cross Blue Shield of Illinois (Payer ID 00621)
- Blue Cross Blue Shield of Kansas City - Freedom Network (Payer ID 31478)
- Blue Cross Blue Shield of Minnesota (Payer ID 00720)
- Blue Cross Blue Shield of New Mexico (Payer ID 00790)
- Blue Cross Blue Shield of Oklahoma (Payer ID 00840)
- Blue Cross Blue Shield of Texas (Payer ID 84980)
- Caresource of Ohio (Payer ID 31114)
- CIGNA (Payer ID 62308)
- First Great West Life & Annuity Ins Co (Payer ID 80705)
- Florida Health Care Plans (FHCP) (Payer ID 59322)
- Fresenus Medical Care Health Plan (Payer ID FMCHP)
- Generations Healthcare (Payer ID GHEDI)
- Golden Triangle Physician Alliance (Payer ID GTPA1)
- Great West Life & Annuity Ins Co (Payer ID 80705)
- Harmony Health Plan of Illinois (Payer ID 14163)
- Harmony Health Plan of Indiana (Payer ID 14163)
- HealthEase (Payer IiD 14163)
- Heritage Physician Network (Houston) (Payer ID HPN11)
- Humana, Inc (Claims) (Payer ID 61101)
- Lincoln National (Humana) (Payer ID 61101)
- Medicaid - Florida (Payer ID 77027)
- Memorial Clinical Associates (Payer ID MCA11)
- Northwest Diagnostic Clinic (Payer ID NWDC1)
- SelectCare of Oklahoma - Tribute (Payer ID SCOK1)
- SelectCare of TX (Houston) (Payer ID HPN11)
- SelectCare of TX (Integranet) (Payer ID ILNET1)
- SelectCare of TX (Kelsey-Seybold) (Payer ID KLSY1)
- Staywell (Payer ID 14163)
- Texan Plus (Houston) (Payer ID HPN11)
- Texas First Health Plans (Payer ID TX1ST)
- Texas First Health Plans (TIOPA) (Payer ID TOPA1)
- United Healthcare (Payer ID 87726)
- United Behavioral Health (Payer ID 87726)
- WellCare (Payer I D14163)
- WellCare CT (Payer ID 14163)
- WellCare HMO (Payer ID 14163)
- WellCare of Georgia (Payer ID 14163)