Auto insurance verification at intake
How EnWella runs eligibility checks the night before every visit, what the badges mean, and what happens when coverage looks wrong.
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- Updated
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- eligibilityinsuranceintakerte
Every booked visit triggers an automatic eligibility check the night before — and again two hours before the appointment if the first one came back stale. Your front desk no longer has to call payers in the morning to find out a patient's plan ended last week; the day sheet already shows it in red.
When verification runs
Three triggers fire an eligibility check: (1) a patient adds or updates an insurance card in the portal, (2) the night before any scheduled visit at 9pm local, and (3) two hours before any visit whose last check is older than 24 hours or returned an error. Manual re-check is one click from the patient header — useful when the patient walks in with a new card.
What the badges mean
Maria Lopez · Aetna PPO
Active · copay $30 · deductible met
James Park · UHC Choice+
Needs review · prior auth required for 90791
Aisha Rahman · BCBS HMO
Inactive · plan ended 2026-03-31
Daniel Kim · Self-pay
Self-pay · skipping eligibility
Active (green) — coverage confirmed for today's date of service. Inactive (red) — payer says coverage ended; the front desk sees this on the day sheet so they can ask before the patient is roomed. Needs review (amber) — payer returned a non-fatal warning (e.g. unmet deductible, prior-auth required, mismatched member ID). Unknown (grey) — payer is offline or the connection is queued; we retry every 15 minutes for 4 hours before paging your billing team. Self-pay rows skip eligibility entirely and show their cash rate at booking.
Cost estimates the patient sees
Aetna PPO · in-network
Visit copay
Per visit · paid at check-in
Deductible remaining
$1,376 of $1,500 met YTD
Co-insurance
Of allowed amount after deductible
Estimate only. Final amount depends on services rendered and payer adjudication.
When a check returns deductible, co-insurance, copay, and out-of-pocket-max, EnWella turns those into a plain-English cost estimate ("Your visit copay is $30; you have $124 left to meet your deductible") that shows in the patient's confirmation email and on the check-in screen. No surprise bills, no awkward conversation at the desk.
When the photo and the payer disagree
If the patient uploaded a photo of their card and our OCR'd member ID does not match what the payer has on file, the check returns Needs review and your front desk sees the photo side-by-side with the parsed fields. One tap accepts what the payer says (90% of the time the photo had a typo); two taps lets staff edit the captured fields and re-run.
Self-pay and unverifiable plans
Patients flagged as self-pay skip the eligibility step entirely; they see a self-pay rate sheet at booking. For unverifiable plans (small payers without a real-time eligibility connection) we mark them Manual and prompt the front desk to call once and cache the result for 30 days.
Audit trail and re-runs
Every eligibility request and response is logged forever — useful for appealing a denial that contradicts what the payer told us at the time of service. Each check has a "Run again" button; running again does not delete the prior log, it just adds a newer one with a timestamp.