Interpreting Eligibility in Stedi

Stedi is our clearinghouse used to check eligibility Follow the steps below to view a client's Eligibility to provide accurate estimate of cost.

Overview Tab

1. Review the Overview Tab of the Eligibility.
   
   1. On the Overview tab to view the Plan and Subscriber details.
   2. Review the Benefit - related entities. Many times this will includes the RAE for Medicaid.
   3. Review the items in red. Items in red are the legal name or dob that the insurance has on file. We should be updating our EHR with the information from the payer, because they must match when sending claims.

Benefits Tab

1. Click on the the Benefits Tab
   Go to the Benefits tab to review the client’s deductible, copay, and coinsurance.
   • Apply the “In Network” filter to display only in-network coverage.
2. Review the Deductible
   Locate the deductible information and compare:
   • Contract Amount – The total deductible required.
   • Remaining Amount – The portion the client still needs to meet.
     These values appear in the left column of the benefits table.
3. Review Service Categories
   Common service categories include:
   • 30 – Health Service (may include only deductible/OOP information)
   • MH – Mental Health (may include inpatient and outpatient, Overcomers only provides outpatient)
   • BY – Physician Visit – Sick ("sick" applies to the services provided at Overcomers)
   • 98 - Professional (Physician) Visit - Office (may say different copays for "general/other" vs. "specialist", Overcomers does not fall under "specialist")
   • 50 - Hospital Outpatient (primarily used for Tricare clients)
     
4. Compare Copay and Coinsurance
   If a copay greater than $0 is listed, it typically overrides the coinsurance amount for that service.
5. View Benefit Details
   Click any benefit row to open the side drawer and view additional details.
6. Document the Information
   • Enter the benefit details into TN.
   • Prepare a Good Faith Estimate (GFE).