> ## Documentation Index
> Fetch the complete documentation index at: https://docs.athelas.com/llms.txt
> Use this file to discover all available pages before exploring further.

# How to Run an Eligibility Check

#### At a Glance

**Eligibility** is the determination of a patient's qualification for healthcare services based on factors such as insurance coverage, benefits, and provider network.

Eligibility checks return one of several results — most commonly **Active**, **Inactive**, or **Inconclusive**. You may also see **Not Covered**, **Pending**, **None**, **Self Pay**, or **Site Responsibility**.

Checks are service-type based and provide tailored recommendations for copay, deductible, and coinsurance. You can map appointments to relevant service types (for example, office visits, physical therapy, or mental health) under **PR Settings → Appointment Rules**.

#### Inconclusive Eligibility Checks: Possible Causes

* **Not all payers are supported.** Our manual team looks up benefits where we can. If you keep seeing inconclusive results, please flag it to us.
* **Missing or malformed data.** We occasionally receive data in unexpected structures. Flagging issues helps us find and fix them.
* **Rules may be misfiring or missing.** An overly inclusive rule can trigger when it shouldn't. Your account management team can help assess your practice's rules.
* **Bad mapping.** Mis-mappings can produce inconclusive results. If a particular insurance repeatedly returns inconclusive, contact your account manager.

### Here's How to Do It

#### Re-run Eligibility for an Existing Appointment

Open the appointment's detail page and go to **Eligibility Central**. Here you can review the current result and click **Re-run Eligibility** to run a fresh check, or **See More Details** to view the full benefits response.

You can also click an insurance's eligibility badge directly in the **Insurances** column of the appointment list to open the response and re-run.

<Note>
  Eligibility can only be run for appointments up to **14 days** in the future.
</Note>

If a check returns **Inactive**, contact the patient and update their information in your EHR — Insights will pick up the change automatically. If you need it sooner, update the information in your EHR **and** on the [Encounter Details page](https://insights.athelas.com/encounter-details).

#### Run a Check for a Patient Without an Appointment

From the [Appointments](https://insights.athelas.com/appointments) page, click **Live Eligibility Check**. A **Run Eligibility Check** drawer opens.

Fill in the patient information, **Insurance Name**, **Provider**, and **Date of Service**. Optionally, you can **Override Service Type** or choose a specific **Source** (clearinghouse) to check against. Then click **Check**.

Results open in an **Eligibility Response** drawer (this can take up to about 30 seconds). If the result is **Inactive**, contact the patient for their latest insurance information and update your EHR accordingly. If it's **Inconclusive**, refer to the causes at the top of this guide.

### FAQ

<Accordion title="Which clearinghouses does eligibility use?">
  Insights checks eligibility through multiple sources, including **Availity**, **Waystar**, **UHC**, **CHC**, **BCBS**, and **Infinx**. The available sources depend on the payer.
</Accordion>

<Accordion title="Does Insights track visit limits?">
  Visit limits are supported for select payers as part of the eligibility response, not as a standalone offering. Talk to our team to understand coverage for your payers.
</Accordion>

<Accordion title="Can I override the service type for a check?">
  Yes. When running a live eligibility check, use **Override Service Type** to run the check against a specific service type instead of the default.
</Accordion>

<Accordion title="Why can't I run eligibility for an appointment far in the future?">
  Eligibility can only be run for appointments up to **14 days** ahead. For appointments further out, run the check closer to the date of service.
</Accordion>