Eligibility

What is it?

You can verify a patient’s coverage in real-time and access a wealth of other detailed information, such as copay and coinsurance details across different services, to allow for a more granular understanding of a member's insurance coverage.

Why is it useful?

Verifying a member's insurance coverage and benefits is a critical step in helping a member get care. The process of checking a patient’s insurance is often quite arduous, requiring photocopying a patient’s insurance card and calling the insurance carrier directly to verify benefits. Ribbon Health Eligibility Check makes this process a breeze.

How does it work?

1. You submit a request through the /eligibility endpoint with relevant parameters (patient name, patient DOB, member ID, and insurance carrier)
2. Ribbon makes a request to the payer for information on that patient's insurance coverage.
3. Ribbon returns coverage summary in a standard JSON format including plan information, progress on deductible and out-of-pocket, specialist copay, and coinsurance.
4. (Optional) You also have the ability to request detailed information on benefits for specific services, such as physical therapy, from payers using service codes. Ribbon utilizes Practice Type codes, which are a more user-friendly abstraction of X-12 service-type codes.

FAQs

• How can I check whether Ribbon's Eligibility endpoint supports a specific carrier?
  -> You can use the insurance_partners endpoint to check available carriers. If you don't see the carrier you're looking for, please reach out to us at [email protected]!