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Electronic Benefit Verification (eBV): FAQ

Electronic Benefit Verification (eBV) questions and answers to help you better understand:


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Transactions and Account Questions

What counts as a transaction?

Any electronic verification requests processed by the payer with a status of Processed - Error or Processed - Success counts as a transaction. These transactions were received and processed by the payer for benefits information and returned to WebPT by the payer with an error or with successful benefit details. Review the All Processed Verifications total on the Electronic Benefit Verification Usage report.  

How many times can I check benefits for the same patient in one day?

There is no limit on when or how many times you run the benefits for the same patient in one day. However, there are several things to keep in mind if you need to run a benefits check on the same patient more than once per day.

  • Remember CMS requires a one-time validation for each NPI before benefits can be approved for the patient. Once the NPI is approved additional requests using the same NPI will process normally.
  • Processing a request on the same day for the same patient, same payer, and same discipline service type that returns with a processed - success result will return the same result each time the process is submitted for that patient on the same day. Only the original processed-successful request will incur a cost for that day.
  • If processing a request on the same day for the same patient and there has been a change to the payer (BCBS to Aetna), the discipline service type (PT to OT), or a change to the NPI it may result in more than one successful (Processed-Success) result and this will count toward the transaction costs.
  • Processing a previously submitted request that originally resulted in a Processed-Error result on the same day for the same patient, same payer, and the same discipline may require changes to correct the submitted information (wrong subscriber ID, DOB, etc.). Submitting a corrected request with the corrected changes resulting in a Processed-Error or Processed-Success result will incur an additional chargeable transaction.    

Oops, I hit the save & check benefits button too many times—will I get charged?

Charges are incurred when you electronically verify a patient’s benefits and you receive either a Processed-Success or Processed-Error result. Once the button is pushed to Save and Verify Benefits WebPT takes you back to the patient chart view. This will require you to complete the entire eBV process again.

  • If the first attempt of the day is processed successfully and the same information (patient, payer, discipline) is processed more than once throughout the same day, no additional charges would be incurred.
  • If each accidental check returns a Processed - Error, additional cost will be incurred for each transaction. 

Am I charged for transactions with errors?

Charges for transactions with errors vary depending on processed status:

  • Processed - Error will incur a charge.
  • Rejected - Error will not incur a charge, this status indicates it was either Rejected by the payer (e.g. the payer site was down or unable to respond timely) and therefore was not processed by the payer.
  • Insufficient Info will not incur a charge, these requests were not sent to the payer for verification since they lack the proper information required to expect a processed result (e.g. NPI is blank or Subscriber ID is blank).

eBV Setup Questions

Click here for eBV Setup Instructions.

Do I need to contact any payers before using eBV?

Certain payers require you to enroll with them before sending patient benefit information electronically. These payers are: 

  • HealthPartners (Minnesota) 
  • Amerihealth 
  • Independence Administrators
  • Highmark Senior Solutions
  • Independence Blue (Pennsylvania)

For assistance with the enrollment program of the payers listed above, contact your WebPT Onboarding Specialist or the WebPT Support Team. Some helpful information to have on hand includes: 

  • Your practice's Group NPI number and Tax ID
  • Your provider's names and NPI numbers
  • Your practice's physical address, phone number, and email address. 

How do I know whether to choose the Group NPI or the provider’s NPI?

When selecting an NPI to use to verify benefits, choose the NPI that you intend to use when billing the claim. The NPI on the claim will dictate if the claim is processed as in-network or out-of-network. When selecting an NPI to use to electronically verify benefits, select the same NPI you would use when calling to verify benefits. 

Why do I see the error "Invalid/Missing Provider ID"?

Certain insurances, such as Medicaid, will validate that the NPI sent is contracted with them. If the NPI sent is not contracted with the payer, the payer's response will be Invalid/Missing Provider ID. Verify that the NPI number in your clinic settings and in the provider's user profile is correct. Additionally, verify that you've made the correct selection when choosing to use the Group NPI or the individual provider's NPI to verify benefits. Another reason you may receive this response is if you have an out of state Blue Cross Shield plan that is mapped to your local Blue Cross Blue Shield verified payer. We recommend mapping out of state BCBS plans to the Blue Exchange verified payer. 

Insurance Mapping Questions

Click here for eBV Insurance (Payer) mapping instructions.

The insurance payer is being rejected, or I can’t find the Insurance payer in the drop-down, can you help? 

  • Use the Export Electronic Payer List to determine the mapping source instead of depending on the payer drop-down to match the Electronic Verified Payer within the insurance payer settings. You can find the Export Electronic Payer List link by clicking on Display Insurance from the Insurance Manager menu.
  • We anticipate you may not find the insurance payer on the list as not all payers are currently offering electronic verification of benefits.
    • HMAA - Hawaii Medical Assurance Association is not supporting benefit transactions at this time
    • Tricare East does not currently provide electronic benefits for Professional Services/Physical Therapy
  • Larger insurance companies often identify Insurance companies regionally or by state. These insurance companies may require you to choose the top payer in the hierarchy to obtain benefits. In the following examples, you would choose the bolded insurance payer:
    • AARP Medicare Advantage > United Healthcare  
    • Humana Gold Plus > Humana
    • Medicare Plus Blue PPO> BCBS of Michigan
  • If you are used to finding specific payer IDs when submitting claims, for this transaction type, we recommend locating the top payer or main payer name.
  • Mapping Blue Cross Blue Shield (BCBS) out-of-state plans to your local or regional brand may result in rejected benefits. 
    • Use Blue Exchange for out-of-state Blue-type home plans, to help avoid benefit rejections. 
    • For any in-state BCBS plans, or BCBS owned plans (such as Highmark), we recommend mapping to the Blue Cross Blue Shield verified payer for your state. 
    • You can potentially avoid these rejections, by adding an additional Insurance Payer profile and mapping it to Blue Exchange.

Medicare Questions

Medicare mapping is not working, how do I fix this?

To ensure Medicare insurances are properly mapped choose Medicare Part A and B from the Electronic Verified Payer drop-down.

AARP is mapped to AARP (A United Healthcare Company) but it is coming back as rejected, isn’t this a valid insurance payer?

If you are receiving rejections during the Electronic verification process when mapped to AARP (A United Healthcare Company) update the mapping to United Healthcare. 

Why do I get the error "Invalid Medicare MBI format" when I verify benefits for patients with a Medicare Replacement (Medicare Advantage) plan? 
This happens when a Medicare Replacement type insurance is mapped to "Medicare Part A and B", rather than to the company that provides the Medicare Replacement plan. Medicare Replacement plans use Subscriber ID numbers, just like the other plans they provide, whereas Original Medicare prefers the use of the MBI number. 
For patients with Medicare Replacement plans, the insurance in their chart should be mapped to the company providing the plan, and the Subscriber ID should be used when adding the payer to the patient's chart. For example, if a patient has a Blue Cross Blue Shield Medicare Advantage plan, it should be mapped to a Blue Cross Blue Shield verified payer, rather than to Medicare Part A and B, and the subscriber ID added in WebPT should be the one from their Blue Cross Blue Shield card, rather than the MBI from their Medicare card. When the insurance is properly mapped, it will send the Subscriber ID or MBI number to the payer in their preferred format.

Patient Benefit Verification Questions

Click here for Electronic Benefit Verification Instructions.

I noticed a blue checkmark on a patient chart instead of a green one. What does this mean? 

When a patient's insurance benefits are electronically verified using eBV, the patient’s chart will show a green checkmark after a successful attempt. A blue checkmark indicates that the patient’s benefits were verified manually by a user in your clinic. For more information about who verified the patient’s insurance benefits, hover your mouse over the checkmark. A message will appear stating when the benefits were verified, and by whom. 

Returned Benefits Verification .PDF Questions

Click here to learn more about the Returned Benefits Verification.PDF.

Some of the information I’m looking for is not included with the payer’s response. Why isn’t that information included? 

Verifying patient insurance benefits electronically is still a relatively new workflow for insurance companies. Some payers may not provide this information electronically, and others may not have as robust an electronic response as they do when contacted by phone, fax, or mail. 

When you send a request to electronically verify patient benefits, we ask for the same information from every insurance company. This is a standard transaction type dictated by the American National Standards Institute (ANSI). Each payer responds to these requests differently, and some payers include more information than others. If information is not present in your returned benefits verification .pdf, the information was not provided to us by the payer. 

How can I tell if an authorization is required? 

Authorization details are often not provided on the Returned Benefits Verification .PDF, or the details are not specific enough to be helpful. To determine if an authorization is required, the best information will come directly from the insurance company. When you send a request to electronically verify patient benefits, we ask for the same information from every insurance company. This is a standard transaction type dictated by the American National Standards Institute (ANSI). Each payer responds to these requests differently, and some payers include more information than others. Due to the variance in payer responses, eBV is not yet able to provide this level of detail. 

When it comes to knowing when authorizations are required, we encourage you to trust the knowledge you already have about insurance companies and their plans, but when you're not sure—call them to be safe. 

INS Verification Report Questions

Click here for INS Verification Report instructions.

What time zone is used in the date verified column? 

The time zone used for the date verified column in the INS Verifications Report is Coordinated Universal Time (UTC). 

How do I resolve the errors in the INS Verification report?

Error Message Resolution
Invalid/Missing Subscriber/Insured ID Verify subscriber ID matches insurance card or check to ensure the correct electronic payer is mapped.
Invalid/Missing Provider ID Verify NPI is listed and valid in Clinic Settings and Provider Profile.
Provider Not on File NPI not contracted with payer.
No Response received - Transaction Terminated Submit the request again.
Patient DOB Does Not Match That for the Patient on the Database Verify patient demographic information entered matches what is on file with the insurance. Correct and resubmit.
Unable to verify insurance, Error Reason: Invalid Participant ID Verify Subscriber ID entered on the patient matches the patient’s insurance card, and verify the insurance is mapped to the correct electronic verified payer. 
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