Eureka.ai • Eligibility Results Dashboard

Insurance Eligibility Overview

Real-time patient insurance eligibility results, powered by NextGen iClaim and surfaced through Eureka.ai for front-office teams.

Practice Connection Status

Connected • Growthhub → iClaim clearinghouse → Payer APIs

Clearinghouse Response Status

Normal latency • Last sync 28 seconds ago

Eligibility Requests (Today)

184

+12% vs. same time last week

Verified Coverage

92%

Successful eligibility confirmations from iClaim.

Pending Responses

11

Requests still awaiting clearinghouse responses.

Exceptions / Mismatches

7

Name / DOB / member ID discrepancies requiring manual review.

Patient Eligibility Lookup

Enter patient and service details. Eureka.ai sends a real-time 270 request through iClaim and surfaces the 271 response in the panels below.

Patient Identifiers

  • Patient name (Last, First)
  • Date of birth
  • Member / Subscriber ID
  • Relationship to subscriber

Service Details

  • Date of service
  • Rendering provider
  • Location / facility
  • Service type (e.g. 30 - Health Benefit Plan Coverage)

Payer Selection

  • Payer name (from clearinghouse list)
  • Payer ID (ANSI)
  • Plan / network (if available)

Request Options

  • Check eligibility only
  • Check eligibility + benefit details
  • Save request to eligibility history

Connection Overview

Each eligibility request flows from the Eureka.ai client portal through Growthhub services into NextGen's iClaim clearinghouse APIs.

Practice → Eureka.ai Portal

Healthy • Practice API connection stable

Eureka.ai → iClaim Clearinghouse

Connected • 270/271 transactions responding within SLA

Payer Response Feed

Real-time • Status, coverage, and benefit segments parsed and normalized.

API Sync Monitor

  • Trigger.dev orchestrates scheduled backfills and retries.
  • Idempotent runs ensure duplicate 270 requests are avoided.
  • Debounced triggers consolidate rapid portal updates.
  • Waits handle long-running payer responses without blocking.

Eligibility Results Panel

All 271 response segments are organized into focused cards so front-office teams can quickly confirm coverage, cost share, and claim readiness.

Subscriber Information

Member: Smith, Jane • DOB: 02/14/1985
Member ID: ABC123456789
Relationship: Self

Payer Information

Payer: Example Health Plan
Payer ID: 12345
Network: PPO / In-Network

Coverage Status

Status: Active Coverage
Effective: 01/01/2024
Termination: 12/31/2024

Plan Details

Plan: Gold PPO 2500
Group #: GRP-987654
Product Type: Commercial • Medical

Benefit Details

Coverage: Office visit • Primary care
Limit: Unlimited • Medically necessary
Service Type: 98 - Professional (Physician)

Copay / Coinsurance / Deductible

Copay: $25 per visit (Primary care)
Coinsurance: 10% after deductible
Deductible: $2,500 individual / $5,000 family

Authorization / Referral Indicators

Precertification: Not required for primary care office visit
Referral: Not required when billed as PCP
Notes: Pre-auth may be required for imaging and outpatient surgery.

Service Type Eligibility & Claim Readiness

Eureka.ai runs rule checks on the 271 response for the requested service type to flag potential front-end claim issues.

Service Type Eligibility

  • Requested: 98 - Professional (Physician)
  • Coverage: Eligible • In-network
  • Site of service: Office • POS 11
  • Benefit: Medical office visit • PCP

Claim Readiness

  • Subscriber & patient demographics match payer file.
  • Coverage active on date of service.
  • Provider & location are in-network.
  • No hard holds or termination indicators returned.

Clearinghouse Response Status

271 Response: Accepted • No errors
Latency: 1.8 seconds
Reference: TRX-2026-03-14-00128

Eligibility History

Searchable trail of all eligibility checks run for this practice across providers, locations, and payers.

Activity Timeline

  • 02:24 PM • 270 sent • Patient: Jane Smith • Payer: Example Health Plan
  • 02:24 PM • 271 received • Active coverage • PCP office visit eligible
  • 01:47 PM • 271 received • Coverage terminated • DOS after termination
  • 11:06 AM • 271 received • Subscriber not found • Exception queued

Exception Queue

Eligibility checks that need human review before the visit can proceed with confidence.

  • Name / DOB mismatch • Payer returned alternate member ID.
  • Coverage terminated • Visit date after termination date.
  • Out-of-network provider • In-network alternative available.
  • Plan not found • Payer ID not mapped in clearinghouse.
  • Invalid member ID format • Fails payer-specific rules.

Each exception links back to the original 270/271 pair, audit logs, and any Trigger.dev automation runs that handled retries or fallbacks.