====== Sharp Revenue — Eligibility & Patient Management Guide ====== Sharp Revenue is ClaimRev's eligibility verification and patient management module. It lets you check patient insurance coverage in real time, manage patient records, track visits, monitor deductibles, and run batch eligibility checks. ---- ===== Getting Started ===== - Navigate to **Sharp Revenue** from the main menu - The top toolbar gives you access to all features: **Patient**, **Practice**, **Payers**, **Batch**, **Quick Check**, **Reports**, and **Accounts** - Some features may not be visible depending on what has been enabled for your account Don't see a feature listed below? Contact ClaimRev to have it enabled for your account. **Just need a fast, one-off check?** Use **Quick Check** to run eligibility, coverage discovery, and other products for a person without saving a patient record. See the **[[guides:sharp-revenue-quick-check|Quick Check guide]]**. ---- ===== Patient Management ===== ==== Searching for Patients ==== Click **Patient > Search** from the toolbar to find existing patients. * Search by name, subscriber ID, date of birth, or other demographics * Click a patient from the results to open their full record ==== Adding a New Patient ==== Click **Patient > Add** from the toolbar. **Required fields:** * First Name * Last Name * Date of Birth * Gender **Additional information you can enter:** * Subscriber ID * SSN * Address and contact details * Payer / insurance information * Clinic assignment Once saved, you can create visits and run eligibility checks for the patient. ==== Bulk Patient Add ==== Click **Patient > Bulk Add** to import multiple patients at once from a file. This is useful when onboarding a new practice or loading patients from an EMR export. ==== Patient Dashboard ==== From any patient record, click **Dashboard** to see an overview of the patient's activity, including visit history, eligibility checks, and claim/ERA information. ---- ===== Running an Eligibility Check ===== This is the core feature of Sharp Revenue. An eligibility check verifies a patient's insurance coverage status in real time. ==== How to Run a Check ==== - Open a patient record (search or create one) - Click **Create Visit** from the patient header - Enter the visit details and select the payer(s) to check - The system submits a real-time eligibility request and returns results within seconds ==== Understanding the Results ==== Eligibility results are displayed per payer in expandable panels. Each panel shows the payer name, coverage status, and a confidence score. === Coverage Status === ^ Status ^ Meaning ^ | **Active** | The patient has active coverage with this payer. | | **Inactive** | Coverage is no longer active. | | **Not Found** | The payer could not find a matching member. | | **Unspecified** | The payer returned a response but did not specify a clear status. | === Confidence Score === The confidence score indicates how reliably the returned data matches the patient you searched for. ^ Score ^ Meaning ^ | **Yes** (green) | High confidence — the returned information matches the patient well. | | **Review** (yellow) | Some data doesn't match perfectly. Review the details before relying on the results. | | **No** (red) | Low confidence — the returned information may not match the intended patient. Check the Mismatched tab for details. | ==== Eligibility Result Tabs ==== Each payer result contains multiple tabs with detailed information: === Quick Info === A summary card showing the most important information at a glance: * **Status** — Active, Inactive, Not Found * **Subscriber ID** — The member's ID with this payer * **Group** — Group name or number * **Confidence** — Match confidence score * **Policy Dates** — Coverage period, COB dates, date added to policy * **Plan Details** — Insurance plan, type, sponsor, plan code, TPA information * **Identifiers** — Subscriber ID, group number, plan network ID, electronic verification code === Medicare === Shown only for Medicare patients. Displays: * Medicare Beneficiary ID (MBI) * Health Insurance Claim Number * Part A and Part B coverage dates * Indicators for Part A Only, Replacement Plan, Railroad Beneficiary, and Qualified Beneficiary * Replacement payer and supplemental plan names === Medicaid === Shown only when Medicaid data is returned. Displays: * Medicaid Recipient ID * Coverage details === Managed Care === Shown when the patient is enrolled in a managed care plan. Displays: * Plan name and program * Managed care subscriber ID * IPA (Independent Practice Association) information === Payer === Full contact and processing information for the payer, including EDI codes and claim processing payer IDs. === Hospice === Shown only if the patient has hospice coverage. Displays hospice provider and coverage information. === Deductibles === Detailed deductible and out-of-pocket information: * **Deductible** — Total annual deductible amount * **Deductible Remaining** — How much of the deductible is left * **Out of Pocket** — Total out-of-pocket maximum * **Out of Pocket Remaining** — How much remains before the maximum is reached * **Lifetime Limit Remaining** — Remaining lifetime benefit limit * **Spend Down Amount** — Medicaid spend-down amount if applicable * **Deductible Monitoring** — Track deductible status over time for this patient and payer === Dependent === Shown when the subscriber has a dependent on the policy. Displays the dependent's name, relationship, and demographic information. === Mismatched === Shown when the data returned by the payer doesn't fully match what was submitted. Compares the requested patient information against what the payer returned — useful for understanding why a confidence score is "Review" or "No". === Hospital Co-Pays === Tiered daily co-pay amounts for hospital stays (e.g., days 1-60, days 61-90, etc.). === SNF Co-Pays === Tiered daily co-pay amounts for Skilled Nursing Facility stays. === Additional Coverage === Information about secondary or supplemental insurance coverage. === Related Entity === Related entities associated with the coverage, such as coordination of benefits contacts, guarantors, or other responsible parties. === Health Benefit Plan === Detailed health benefit plan coverage information when provided by the payer. === Benefits === A searchable list of all benefit types returned by the payer. Use the filter to search by benefit type code (e.g., select "Health Benefit Plan Coverage", "Professional (Physician) Visit - Office", etc.) and click **Search** to narrow results. === Validations === Any validation messages or errors returned by the payer. Common validations include: * Missing or invalid subscriber ID * Patient not found on file * Service temporarily unavailable === Conversation (AI) === Don't see this tab? Contact ClaimRev to have AI features enabled for your account. An AI-powered chat interface where you can ask questions about the eligibility results in plain English. For example: * "Does this patient have a deductible?" * "Is this patient covered for physical therapy?" * "What is the co-pay for an office visit?" ---- ===== Visits ===== Visits represent a scheduled or completed patient encounter. Each visit can have one or more eligibility checks attached to it. ==== Creating a Visit ==== - Open a patient record - Click **Create Visit** in the header - Enter the visit details (date, provider, payer, diagnosis codes, procedure codes) - The system will automatically run an eligibility check when the visit is created ==== Viewing a Visit ==== From the patient record, click on a visit to see: * Visit details (date, provider, location) * Eligibility results for that visit * Diagnosis and procedure codes * Linked claims and ERAs ---- ===== Practice Information ===== Click **Practice** from the toolbar to view and manage your practice information. This includes: * Practice name and NPI * Address and contact details * Provider information This data is used when submitting eligibility requests to payers. ---- ===== Payer List ===== Click **Payers** from the toolbar to browse and search the master payer list. The payer list shows: * Payer names and codes * EDI identifiers * Claim processing payer IDs Use this to find the correct payer when setting up patients or running eligibility checks. ---- ===== Quick Check ===== Click **Quick Check** from the toolbar to run eligibility, coverage discovery, and other products for a person //without saving a patient record//. It's the fastest way to run a one-off check — enter a name, pick the products to run, and hit **Run**. For full details, see the dedicated **[[guides:sharp-revenue-quick-check|Quick Check guide]]**. ---- ===== Batch Processing ===== Don't see Batch in the toolbar? Contact ClaimRev to have batch processing enabled for your account. Click **Batch** from the toolbar to manage batch eligibility files. Batch processing lets you submit eligibility checks for many patients at once rather than one at a time. * Upload a batch file of patient/payer combinations * Monitor batch processing status * View results when processing completes ---- ===== Reports ===== Click **Reports** from the toolbar to access reporting features. ==== Latest Eligibility Report ==== Shows the most recent eligibility check results across all patients. Use this to: * Review recent activity * Spot failed or problematic checks * Re-open results without navigating to individual patients ==== Transaction Search ==== Search the full history of eligibility transactions by date range, patient, payer, or status. Useful for: * Auditing past eligibility checks * Finding a specific transaction * Tracking transaction volume over time ---- ===== Accounts ===== Click **Accounts** from the toolbar to set your default account. If you have access to multiple ClaimRev accounts, this controls which account's data is displayed throughout Sharp Revenue. ---- ===== MBI Finder ===== If you have a patient's old Medicare member number (HICN) and need the new Medicare Beneficiary Identifier (MBI), the MBI Finder can look it up automatically as part of the eligibility process. ---- ===== Tips & Best Practices ===== * **Always verify payer selection** — Using the wrong payer code is the most common cause of "Not Found" results. Check the Payer List if unsure. * **Check the Mismatched tab** when confidence is low — It shows exactly what the payer returned vs. what was submitted, helping you identify the mismatch. * **Use Deductible Monitoring** to track patient deductible status over time rather than running a new eligibility check every visit. * **Review Validations first** if a check fails — The validation messages from the payer usually explain exactly what went wrong. * **Keep Practice information up to date** — Payers may reject eligibility requests if the submitting provider NPI or practice details don't match their records. ---- //Need help? Contact ClaimRev support at [[mailto:help@claimrev.com|help@claimrev.com]] or call 918-842-9564.//