Online Eligibility Check (OEC/ECF/ECO)

Type of eligibility check	Used by	What it checks
Online Eligibility Check (OEC)	Hospitals, day surgeries and health professionals	An OEC checks your patient’s eligibility for treatment of a presenting illness or condition on the admission date. The check includes their hospital insurance product, including: out-of-pocket expenses for excess exclusions co-payments. The check also includes the medical services covered by: Medicare benefits their private health insurer. An OEC checks hospital and medical eligibility with both private health insurers and us.
Eligibility Check Fund (ECF)	Hospitals and day surgeries	An ECF checks your patient’s eligibility for treatment of a presenting illness or condition on the admission date. An ECF only checks hospital eligibility. It’s based on their hospital insurance product, including: out-of-pocket expenses for excess exclusions co-payments.
Eligibility Check Medicare (ECM)	Hospitals, day surgeries and health professionals	An ECM checks if Medicare benefits are payable for in-patient medical services. An ECM only checks Medicare eligibility.
Eligibility Check Overseas (ECO)	Hospitals, day surgeries and health professionals	ECO is used when a patient holds overseas health insurance and you need to verify their eligibility for treatment in Australia.

Prior to generating an Informed Financial Consent (IFC) an Eligibility Check should be carried out
There are two parts of verifying a patient's Health Fund Membership
- Verify Fund returns if they have cover
  - From the List View with right-click Verify Patients, or
  - From Client - Insurance
- Eligibility Check confirms if they have cover for a procedure

Carry out an Eligibility Check

This is usually completed at time of Consultation
On the List View select the Checkbox in the OEC column for that patient. This opens the Client Record Insurance section

Select the IFC and Eligibility Check button
The IFC / Estimate opens
Enter Procedure Codes or select a Standard Procedure to populate
Select OEC or ECF on the sidebar
- The OEC requires Medicare Item Codes
- For the Eligibility Check Fund ONLY (ECF) enter a Presenting Illness Code ... ECLIPSE | Private Healthcare Australia (PHA

Select Print on the Sidebar to print to screen and it will save as a PDF in Client Communications

Select Print on the Sidebar to print to screen and it will save as a PDF in Client Communications
Any Excess and/or CoPayment will save to Client Insurance to populate on the IFC

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