Insurance and what the patient owes · 2 of 7
Turning eligibility on
Three things have to be true before Mesio can ask a carrier anything. Two are about you. The third is about each patient, and it is the one that actually fails.
Checking eligibility means asking a carrier a question on your behalf. Three things have to be in place for the question to be askable at all.
Your NPI, because the carrier is answering a provider
A carrier does not answer questions from software. It answers a provider asking about a patient, and the NPI is how it knows who is asking. Without one, nothing goes out. This is a single field, entered once.
Your zip, because prices are local
This one catches people out, because it looks like an address field rather than a pricing input.
Out-of-network estimates are priced against what a procedure is typically allowed in your area, and your zip is what selects the area. Prices vary more within one metro than between metros, so this is not a formality. Leave it blank and every out-of-network estimate loses its basis and falls back.
A missing zip fails silently. Nothing errors. Estimates just quietly get worse, and a practice with no zip saved looks identical from the outside to one that is working perfectly. If your out-of-network numbers seem vague, check this first.
The patient's insurance details, which you already have
Mesio uses the insurance information already sitting in your practice management system to run a live query against that patient's current status with their carrier. Nothing is retyped, and nothing is entered twice.
The practical consequence is simple. A patient whose insurance details are complete in your system comes back with a real answer. A patient whose record is thin is the one that comes back blank, and the fix is in the practice system rather than in Mesio.
What you will see when it cannot answer
Mesio separates the ways this fails, because they have different fixes and only some of them are yours. A carrier it has not yet learned to reach is a different problem from a carrier that answered and did not recognize the patient, and both are different from a payer being down. You are told which one happened rather than being shown a generic failure.
The payer-is-down case is worth knowing about, because it is the one that used to poison a whole day. An answer that means the carrier could not respond is never recorded as though it were the carrier saying no. It is not remembered at all, so the next attempt is a real attempt rather than a replay of the outage.
Your NPI, your zip and the carrier checklist are all on this one screen.