Eligibility

Across the United States, approximately 25% of all health care claims are rejected the first time that they are submitted. Of those rejected claims it is believed that 80% are rejected for reasons a ssociated with eligibility verification. Download from below NEHEN's Eligibility Best Practices Guide and the Eligibility Batch Verification Setup Guide to learn how to dramatically reduce claim denials.

Batch Eligibility Verification Setup Guide
This guide describes the technical steps required to setup batch eligibility verification inquiry submission through NEHEN.

NEHEN Eligibility Best Practices
This Eligibility Best Practice guide is published to assist our Members in understanding the eligibility EDI transaction, the options available to NEHEN Members for implementing this transaction and the best practices for eligibility verification as provided by NEHEN Payers, Providers, and Program Management. Included in this document is a summary of supported Search Options and Payer Response Content.