The BridgeGate Eligibility module quickly determines a member’s eligibility for specific procedures based upon diagnosis and other supporting information in real-time and obtains a member’s appropriate formulary information from the pharmacy benefit provider.

Features

• Specific EDI templates allow you to perform enrollment and eligibility tasks more efficiently and with better data
• Employee, customer and partner information to be accessible from one central, real-time location
• User-friendly dashboard provides at-a-glance information to make better decisions

Benefits

• Determining health plan member benefit level and co-pay (eligibility) occurs faster
• Determine a member’s eligibility for specific procedures based upon diagnosis and other supporting information in real-time
• Obtain a member’s appropriate drug-based diagnosis from the pharmacy benefit formulary as well as potential step-therapy guidance

Built-In Templates

Healthcare Member Eligibility

ANSI X-12 EDI 270/271 – HIPAA 4010A1/5010

Pharmacy Benefit and Formulary Eligibility

NCPDP – Formulary and Benefit Standard Implementation Guide v2.1

HIPAA Compliance Framework
Billing & Claim Module | Enrollment Module | Eligibilty Module