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How to Validate Patient's Insurance Eligibility

Hello I am new to OpenEMR and wanted to know how to check Patient’s insurance eligibility in OpenEMR 5.0 Thanks!

hi @NewEmrUser, are you talking about batch verification? if so, please this thread Eligibility Response not parsing into table

I am sorry, I should have provided more details.

I am looking for individual patient’s insurance eligibility verification. If new/existing patient is coming for a visit, we would like to verify if the patient’s insurance is still valid prior to visit. Is there any functionality in OpenEMR? or is there any alternate way that other clinics follow. Thanks!

no prob, it would be “batch verification” then so you would want to follow the guide here simple fix to segment delimiter by stephenwaite · Pull Request #1066 · openemr/openemr · GitHub


Currently , OpenEMR doesn’t have this feature ( To validate insurance eligibility in live ).
We can achieve this live insurance eligibility check by integrating OpenEMR to Third Party Clearing House ( like Zirmed ).
It requires some code customization .
1.We need to send patient policy number and some other mandatory values in the api call
2.Then We will receive the eligibility response of the patient accordingly .

Let us know if you have further clarifications.


Thank You All!

hello openemr team,
is this implemented in version six? we wanted to intergrate openemr with our national insurance using API so that when we enter patient insurance number it shoud return the validity of his insurance status if active or expired or he is not a member. or any other way so that we can not register a patient with fake ID.
as the above @visolveemr explained