How to Transmit Eligibility Files
Eligibility files should be generated with a Bill Date equal to one month ahead of the current month.
Eligibility files contain all active members effective as of the future month selected as the file's parameters. For example, files generated in the month of June for the month of July will contain all current active members and new members that have coverages with an effective date on or before July 31st.
Eligibility files contain records for all members with an active coverage as of the selected Bill Date. The file also includes any employee records that have been modified or terminated within 60 days prior to the Bill Date. For example, if the file is generated for July, it will only contain records with termination dates that span between May and July. So, if a retro termination date entered is equal to April 30th or earlier, the record will not be added to the file. The insurance carrier will produce a Default Cancel report that should be reviewed after each file is processed with the carrier.
The following steps should be used to generate and transmit eligibility files:
From the BenTek Menu, click on Vendor Billing/Eligibility.
A page with Eligibility, Billing, and Generated Files sections will appear.
Enter the month and year within the Run Date field.
Within the Eligibility/Options section, select the desired plan option by checking the box located to the left of the plan's name.
Click "Run" to generate the file.
A loading icon will appear while the file is generating and an alert will notify when the file is available.
Always choose one month ahead of the current month except during annual Open Enrollment. For example, if the current date is December 15th, choose January from the drop-down list. Please contact BenTek Client Services for specific instructions concerning the process for annual open enrollment.
Make sure that the session time does not expire while generating the file.
The eligibility file will only show the Physician number (PCP, PCD, or PDP) for coverages that have an effective date that occurs within one month of the file's Bill Date. For example, if the eligibility file is generated in the month of January (the selected month would be February), the file would only show a coverage's Physician number if the coverage's effective date occurs within one month of the file's Bill Date; the Physician number must also be added prior to the respective Bill Date.
Once complete, the file will display under the Generated Files section.
To view the file, first ensure that the Search Date within the Generated Files section matches the date used to generate the file.
Click the Send icon corresponding to the file to be transmitted to the appropriate carrier.
Administrators may download the file by clicking on the file name within the Preset Name column.
The eligibility file can also be removed by clicking on the Delete icon.
An alert will appear to confirm the deletion of the file.