What steps are involved in benefits verification and eligibility in EPIC Resolute before patient service?

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In EPIC Resolute, the steps for benefits verification and eligibility before patient service focus on confirming the patient’s current coverage and estimating what they’ll owe. You start by opening the Eligibility/Benefits function and pulling payer data for the planned service date. You verify that there is active coverage and identify the exact plan, subscriber, member ID, and relationship to the subscriber. Next you review the benefits details: copay or coinsurance amounts, remaining deductible, out-of-pocket maximum, and any plan limitations or exclusions that could affect coverage. You also check for any preauthorization requirements, frequency limits, or other constraints that might apply to the service, and determine whether the service is in-network or out-of-network.

With all of this information, you estimate the patient’s financial responsibility, so the patient and the care team know what to expect and upfront collection actions can be planned if needed. If a service requires preauthorization, you would initiate that step after verifying benefits, but you don’t perform preauthorization before confirming eligibility and benefit details. This sequence ensures you’re not chasing approvals for a service that isn’t covered or would incur unexpected costs for the patient.