Insurance Eligibility Verification
Last updated: June 11, 2026
Please refer to the training video below for a tutorial of the insurance eligibility tool:
Overview
Our insurance eligibility check helps assess the financial viability of accepting a patient by providing reimbursement information and identifying potential payment issues before admission.
Running an Insurance Eligibility Check
Verifying insurance coverage is a critical step in the referral process. Exacare connects directly to Inovalon to provide insurance eligibility information.
How to Run an Eligibility Check
Click the Screener tool in your navigation bar to view all of your referrals.
Select the Patient Referral you want to review.
Select the Insurance tab. Our AI automatically identifies and fills in missing insurance details using data pulls (like Member ID, DOB, Payer) from the referral packet.
Verify Information: Ensure the insurance payer and Member ID are correct. If there are any blanks, leverage the 'Facesheet', the 'Report' or 'Data Pulls' tabs to fill in the blanks.
Run the Check: Click 'Next'. Exacare will pull the referrals' insurance eligibility details from Inovalon.
If the patient has multiple providers (e.g., secondary insurance), you can repeat this process to verify additional coverage. The insurance check history will be available in this tab after running your first check.
Understanding Your Results
Once the check is complete, you will see a detailed summary of the patient's insurance coverage.
Sample information (Note: information availability varies per payer)
Eligibility Summary: Coverage details and dates.
Health Benefit Plan Coverage: Insurance type, period, deductible, LTR, co-payment.
Skilled Nursing Coverage: Period, co-pay amounts, deductibles.
SNF Days Remaining: Full coverage, co-insurance days, most recent SNF stay.
Payers provide different levels of information in Inovalon. For example, Medicare tends to provide the most detailed information. If you are looking for additional information that was not found during the check, we recommend you call the payer directly or check with other platforms available to you.