Describe a scenario where insurance eligibility denial occurs at check-in and how to handle it in Phreesia.

• A. If eligibility is denied or benefits unavailable, staff should inform patient, explore alternate payment, verify coverage with payer portal, collect necessary information, and log the issue.
• B. Deny the patient access to the facility and cancel the appointment.
• C. Proceed with the visit and bill the patient without further checks.
• D. Ignore the denial and document nothing.

Answer: (A)

When eligibility is denied at check-in, the proper approach is to follow a patient-centered workflow that ensures financial clarity and documents the issue in Phreesia. If benefits are denied or unavailable, staff should inform the patient, explore alternate payment options, verify coverage with the payer portal, collect any required information for follow-up, and log the issue in Phreesia. Informing the patient sets expectations and maintains trust. Exploring alternate payment options might include moving to a self-pay rate, arranging a payment plan, or checking for any applicable charity or discount programs. Verifying coverage with the payer portal helps determine whether the denial is final, a data problem, or requires additional steps like re-certification or authorizations. Collecting the necessary information—such as updated insurance details, subscriber information, and contact data—builds a complete record for billing follow-up. Logging the issue ensures the denial is tracked so the office can pursue next steps with the payer or the patient and document the actions taken.

Denying the patient access or canceling the appointment, proceeding with the visit and billing without checks, or ignoring the denial would bypass essential financial clearance and compliance steps, leading to potential nonpayment and administrative problems.