Eligibility Tools & Resources

Verifying a patient’s eligibility is essential to determine coverage under a health insurance policy or MassHealth. The resources on this site include useful information and directions for providers and their office staff to confirm a patient’s eligibility for coverage.

It is important to check eligibility to:

• bill for services rendered
• determine copayments
• meet timely filing deadlines
• reduce claims rework
• make arrangements for financial assistance before an office visit
• improve office efficiency

Resource Materials

Eligibility Resource Guide
The document describes methods to check eligibility electronically, including direct links to free payer websites and other methods for checking eligibility, all summarized in one simple to use document.

A Guide to Member ID Cards
This document includes a sample insurance ID card and explanations of common terminology.

Helpful Hints
This document provides tips to avoid common claim denials and rejections by using eligibility verification.

NEHEN Training Links