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Eligibility checks let you verify a patient’s insurance coverage and benefits in real time. You can run a check from the Eligibility Checks section in the left menu. If the patient doesn’t exist in Solum yet, you can create their record directly from the results.

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Quick Start

  1. Go to Eligibility Checks in the left menu.
  2. Click New Eligibility Check.
  3. Enter the patient’s First Name, Last Name, Date of Birth, and Member ID.
  4. Enter your Provider NPI.
  5. Select the Insurance Payer.
  6. Set the Date of Service and Service Type.
  7. Click Verify Insurance.

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Step-by-Step

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Opening a New Check

  1. Go to the left menu and click Eligibility Checks. Eligibility Check1
  1. Click the New Eligibility Check button in the top right corner.
    New Eligibility Check

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Entering Patient Information

If the patient already exists in Solum, use the Search existing patient bar at the top to find and pre-fill their details. If the patient has not been created in Solum yet, enter their information manually:
  1. Fill in the following fields:
Enter all information exactly as it appears on the insurance card. Do not include middle names in the First Name field. Payers are strict, and small discrepancies can result in a Failed status.

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Provider and Insurance Information

  1. Enter your Provider NPI in the Provider Information section:
Your NPI is a 10-digit number. If you’re unsure which NPI to use, check with your billing team or contact support@getsolum.com.
  1. Select the Insurance Payer from the dropdown.
You can start typing the payer name to search and scroll to find the correct option.
If you’re unsure which payer to choose, email support@getsolum.com and the Solum team will help you identify the correct one.

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Encounter Information

  1. Select the Date of Service.
You can choose today’s date or a specific past date if needed.
  1. Select the Service Type from the dropdown.
For general health benefits, you can use Service Type 30. We recommend running only one service type at a time for the most accurate results.
Examples:
ABA: CF
Speech Therapy: AF
Occupational Therapy: AD
Physical Therapy: PT

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Running the Check

  1. Click the Verify Insurance button.
The system will process the check and return the eligibility results.

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Reviewing Results

  1. Once the check is completed, you will see the eligibility results on screen. At the top, you will see whether the patient’s coverage is Active or Inactive. Inactive Active
If the patient has active coverage, there are two main tabs to review: Overview and Benefits.
Tabs

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Overview Tab

The Overview tab gives you a high-level summary of the eligibility response. It is organized into the following sections:
The Benefit - Related Entities section can show important details like Utilization Management Organizations. For example, if physical therapy benefits are managed by a separate organization, their contact number will appear here. This is useful when you need to call for prior authorization or additional benefit details.

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Benefits Tab

The Benefits tab shows the full detail of the patient’s coverage. This is where you find deductibles, copays, coinsurance, and any limitations. The benefits are displayed in a table. You can filter the results using the filter buttons at the top of the page: Type Filter — Filter benefits by category: Coverage Level Filter — Filter by who the benefit applies to:
  • Employee Only — Benefits for the subscriber only
  • Individual — Benefits for one covered person
Network Filter — Filter by network status:
  • In-network — Benefits when the provider is in the payer’s network
  • Out-of-network — Benefits when the provider is out of network
  • Both — Benefits that apply regardless of network status
  • Not set — The payer did not specify a network indicator
Service or Procedure Filter — Filter by specific service type codes to see only the benefits relevant to the service you ran.
The best way to see benefit information specific to the service type you ran is by clicking Match to Patient. This will organize the results clearly by the service type and make it easier to review the patient’s responsibility for that specific service.

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Matching Results to a Patient

  1. Click Match to Patient at the top of the results page.
If the patient already exists in Solum, search for their name and select them. If the patient does not exist yet, select Create new patient from the dropdown.
  1. Review the insurance information. You can adjust it if needed, or click Create New Insurance Automatically to use the details returned by the payer.
  2. Confirm the Payor Responsibility (Primary, Secondary, or Tertiary).
  3. Click Match & Create Records. Match Patient
Caption: The Match Settings modal where you can create a new patient or match to an existing one

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After Matching

  1. Go to the Workflow section in the left menu.
You will see the patient listed under the Needs VOB stage.
  1. Click on the patient profile to view their details.
At the top of the profile, under the Payors tab, you will find the eligibility details that were just verified.

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Troubleshooting