Verifying Patient Benefits with VOBGetter℠

Use VOBGetter℠ to instantly receive information about the patient's insurance eligibility and benefit coverage. Let's review the patient and insurance information required to be present for the VOBGetter to function as expected.

New to VOBGetter? Check out these instructions to complete setup and permission users. 

Verifying Benefits with VOB Getter Overview Video

VOBGetter℠ Eligibility Checks

Ensure the following information is included on the patient Information tab (also known as the factsheet).

From the Information tab, click Edit Patient. 

Patient Information

Confirm that the following fields are complete and accurate:

• First Name
• Last Name
• Gender
• DOB
• SSN (if required in your instance)
• Address

Insurance Information

Ensure that all required fields (indicated with an asterisk (*)) are entered and use the tips provided to minimize errors. The Claims address fields are not used for VOBGetter eligibility checks.

• Insurance Payer: Select the insurance using the Subscriber ID when available or Payer Name. Free text is not supported.
• Subscriber ID: Don't include spaces, slashes, or dashes.
• Effective Date: Select from the calendar.
• Group Number: Don't include spaces, slashes, or dashes. If the group number is not provided, enter five zeros here (e.g., 00000) 
• Payer Type: You must select a payer type from the drop-down when the insurance is Medicare or Medicaid.
• Claims Information: These fields are optional and available for all patient insurance companies.
• Subscriber Information: Required fields include
  • Relationship to the client
  • First Name and Last Name
  • Date of Birth
  • Gender
  • Address
  • Important: If the subscriber is not known, or any of the required information for the subscriber is missing, select Self for the Relationship drop-down.
• Although not a requirement for using the feature, it is helpful to upload a clear picture or scan of the Patient ID and Insurance Card.

Note: If the insurance plan is marked as inactive, the Termination Date field will have an asterisk (*) beside it, indicating that it is a required field.

Insurance Selection Tips

Enter the first three characters of the payor ID or payer name into the Insurance Payer field. These can usually be found on the back of the insurance card. Select the correct Payor ID (in blue) from the list that appears. 

If Payor ID is not found, please use the following table:

Payor Name	Card May Say	Payor ID	Comments
Blue Cross and Blue Shield (BCBS)	BCBS	Depends on the state the facility is registered to	Some BCBS payers may also refer to BCBS as Blue Sheild, Blue Cross, Anthem, and Highmark. There are special BCBS subentities, but will still be treated the same. Verify using the BCBS entity that the facility is registered to.
United Healthcare (UHC)	United Health Care	87726 is the most common	UHC has many different subsidiaries, refer to the back of the card where available to look for subsidiaries and the associated names/payor IDs.
Golden Rule	United Health Care	37602	-
Neighborhood Health Partners (NHP)	United Health Care	96107	Do not confuse with this payor ID 05047 Neighborhood Health Plan of Rhode Island, these are managed by different entities.
United Medical Resources (UMR)	United Health Care	39026	Formerly known as Wasau.
Oxford	United Health Care	6111	41194  is formerly United Resource Networks.
Optum	United Health Care	41161, 41194	-
Beacon	Beacon	87726	Beacon is a carve-out to Empire and UHC, use UHC to verify.
Aetna	Aetna	60054	Aetna has several subsidiaries, but 60054 is the most popular verification option. This should always be tried first unless the card specifically stipulates a different insurance.
Coventry	Coventry of x state (x = state name)	25133	Coventry has been bought out by Aetna but still has its own payer IDs. 25133 is the most popular but Conventry payor IDs may vary by state.
Mail Hander's Benefit Plan	Coventry, FEHBP	COVTY00251, 00251	Coventry bought out MHBP prior to being bought out by Aetna. 00251 is the more popular.
Cigna	Cigna	62308	Cigna has multiple subsidiaries, but 62308 is the most popular. Always try this first unless the card specifically stipulates otherwise.

Verification

Manual verification can be completed from the patient facesheet (Information tab) when viewing or editing the patient record. This button is located beneath the patient's insurance information. 

1. To verify benefits, click on the VOBGetter℠ Instant button.
2. Once clicked, the button will display Processing Request.
3. Once processed, the page will redirect to the top of the facesheet and display a notification.

4. Scroll down to the Insurance section to view the results.

5. Click on the Status to view benefit information.
   

Patient Verification History (Hx)

In the Insurance section of the patient's chart, click on the Hx button to show a history of all verification events for the policy.

VOB Results Statuses and Error Messages

Results are color-coded in the Kipu EMR for easy visual identification:

Active (Green) Active with Restrictions (Yellow) Inactive (Red) Results Needing Review (Grey)
If your organization has enrolled in Medicare/Medicaid verification services, these responses will be highlighted in Blue, along with results details for Parts A, B, C, and D as reported by the payor.

Reviewing Error Messages

If you receive an error message or a result that requires further investigation: 

1. Click on the Status in the dialog box will open the details for that eligibility check.
2. From the VOB Getter Message window, you can review the error and rejection reasons listed and a brief description.
3. If you need additional information, please consult the Error Codes table below.

Error Codes

42	Unable to Respond at Current Time	Health Plan is not able to serve a response in less than 20 seconds at this time. (Eligible automatically tries twice)
41	Authorization/Access Restrictions	Health Plan may require you "enroll" the NPI you are using before allowing transactions. To complete the enrollment for this error code, please submit a ticket to [e-mail].
50	Provider Ineligible for Inquiries	Health Plan may require you "enroll" the NPI you are using before allowing transactions.
51	Provider not on file	Health Plan may require you "enroll" the NPI you are using before allowing transactions.
71	Patient Birth Date Does Not Match That for the Patient on the Database	DOB does not match
43	Invalid/Missing Provider Identification	NPI number was not found in health plan DB - could not authenticate
45	Invalid/Missing Provider Specialty	Provider taxonomy code is invalid/missing
72	Invalid/Missing Subscriber Id	Member ID did not match health plan records.
73	Invalid/Missing Subscriber/Insured Name	Member Name did not match the health plan records.
75	Subscriber/Insured Not Found	Member was not found.
76	Duplicate Subscriber/Insured ID Number	Member could not be identified with the subscriber id provided due to multiple entries matching the data content. Please check your parameters and try again
79	Invalid Participant Identification	Invalid Participant Identification
80	No response received	Transaction failed at the health insurance company
0	Member was found but plan has expired or is inactive	Member is inactive.
99	Member id submitted is a prior identification number	Rejected due to member id submitted is a prior identification number. The member id must be the most up to date id number. Please correct and resubmit.
100	Some error prevented the insurance company from responding.	Some error prevented the insurance company from responding. Check your parameters and try again.
E3	Requested Record Will Not Be Sent	As per medicare HETS rules, duplicate eligibility requests using the same NPI/HICN combination are not allowed in the same 24 hour period. Please try again after 24 hours.
408	Request timed out.	Request timed out.

Common Errors and Resolutions

Click on each error below to review the resolution.

• This is an error related to the payor or the clearinghouse not being able to receive the request. 

  Resolution: Please contact Support and advise them the request was unable to connect. Our VOB Partner LeeRCM will work with the clearinghouse to resolve the connectivity issues. 

• This occurs when the Tax ID/NPI is not registered with the payor.

  Resolution: Please complete the required credentialing process with the payor. Reach out to Support with questions. 

• This error means that there is something wrong with one or more of the following items:

  • Patient Name 
    • Confirm the patient's legal name. The easiest thing is to check if the patient's ID has been uploaded to the chart and review the information there. 
  • Patient DOB
    • Confirm the patient's date of birth. The easiest way to do this is to check if the patient's ID has been uploaded to the chart and review the information there.
  • Insurance Company Selected
    • Review the patient's insurance card, especially the back of the card, and look for information about where claims should be submitted. This will often mention a specific name and sometimes a payor ID. Try searching the Insurance name or ID in the Insurance Company field. 
  • Policy Number
    • Review the uploaded images of the patient's insurance card to confirm the Policy Number was entered without typos. 
  • Group Number
    • Review the uploaded images of the patient's insurance card to confirm the Group Number was entered without typos.  

VOBGetter Notifications

Depending on how notifications have been configured for your organization, you may receive notifications related to patient eligibility. Click here for instructions on managing your notifications.

• VOBGetter Status - Active: The patient's insurance verification was successful and the patient has active coverage. 
• VOBGetter Status - Inactive: The patient's insurance verification process was successful and the patient doesn't have active coverage. 
• VOBGetter Status - Error: The patient's insurance verification was unsuccessful and there is a resulting error.