What is Patient Eligibility 270/271?

The Health Care Coverage, Eligibility, and Benefit transactions are designed so that inquiry submitters (information receivers) can determine (a) whether an information source organization (e.g., payer, employer, HMO) has a particular subscriber or dependent on file, and (b) the health care eligibility and/or benefit information about that subscriber and/or dependent(s). The data available through this transaction set are used to verify an individual's eligibility and benefits.

Medicalinx via Surescripts Eligibility Services for Medicaid allows Medicaid MMIS vendors to request patient eligibility information in real time from payer and PBM organizations that are connected to Surescripts , the Nation's E-Prescription Network.

Our Certified Eligibility solution by Surescripts can be an effective enhancement to your onsite infrastructure or can also be used as an independent solution. Our Eligibility solution is developed with the latest technologies and is able to be integrated with several Practice Management Systems and an EMR/EHR solution.

For More Information:
Contact EligibilityInfo@medicalinx.com or call 1-866-429-5015

What is Patient Formulary?

A patient formulary is a list of prescription medications that a drug plan will pay for. When medications are not listed on a PDP’s (Prescription Drug Plan) formulary, then the drug plan will not pay for them unless an exception is granted.

Medicalinx’s unique Certified Formulary Solution by Surescripts contains an in depth formulary databank which can provide the prescriber with a list of covered drugs including tier information as well as other therapeutic alternatives within the formulary.