AbacusRx

Enhance Eligibility Check

The software will verify and retrieve all the patient's commercial insurance and Medicare part D insurance information and creates all the insurance records for you.

Enter the patients name, date of birth and the last four digits of their SSN and you can get all your patients coverage information (Plan, Group number, Card number, person code and relationship for Medicare part D or Commercial Insurance).

Here is a scenario of how it can work for you:

A customer arrives at your counter with her sick child and a prescription, but no insurance card. You use the information on her family’s file to submit her claim, but it won’t go through. She remembers that her husband’s company recently changed insurance plans, and cards from their new provider haven’t arrived in the mail.

That’s not a problem for you or your customer when your pharmacy is connected with our Commercial E1 eligibility. This eligibility lookup service allows pharmacies to easily get updated benefit information to successfully run a claim when the member’s card is not available, or when information on file is no longer accurate.

With E1, you can automate the task of determining eligibility and coverage for:

• Patients with no insurance or prescription benefit card

• Patients who have changed plans or who present the wrong information or card

• E-Prescriptions that arrive for patients with no benefit information on file

You can improve staff efficiency and enhance customers’ overall experience when you’re able to quickly determine eligibility under these circumstances. Everyone’s goal is achieved when the customer leaves with the filled prescription.

The Commercial E1 has benefits unmatched by other vendors offering similar services. It provides eligibility information on more than 220 million people enrolled in commercial, Medicaid and Medicare Pharmacy Benefit Plans participating in the Surescripts^© e-Prescribing Network. And, a exclusive three-point matching system confirm each submission. If a response doesn’t meet the criteria, you won’t be charged a transaction fee.