Eligibility Watchdog
Eligibility Watchdog is CareIncite's core Capture Money feature. It continuously monitors the insurance eligibility status of every active client in your practice and surfaces coverage issues before you deliver services that may not be reimbursed. For Medicaid-heavy practices, this is the single highest-impact feature in CareIncite.
Why eligibility lapses cost you money
In behavioral health, Medicaid coverage can lapse silently. A client's coverage may end due to missed recertification, a change in household income, enrollment in a different MCO, or administrative errors at the state level. When this happens, the practice typically finds out only after submitting a claim — sometimes 30 to 60 days after the session was delivered.
By that point, multiple sessions may have been delivered to an ineligible client. The revenue is unrecoverable. Eligibility Watchdog prevents this by checking coverage status proactively, on a schedule you configure, so you know about lapses before the next session — not after the next claim denial.
Automatic coverage expiration
CareIncite runs a daily automated job that checks every client's policy end date. When a client's coverage end date has passed, the system automatically marks their coverage status as Inactive. This eliminates the common problem of clients showing “Active Coverage” long after their authorization has expired, ensuring your KPIs and reports always reflect reality.
How it works
Eligibility Watchdog runs eligibility verification checks against your active client list on a recurring schedule. When a client's coverage status changes, CareIncite flags the client and surfaces them in the Eligibility module with the specific issue identified.
KPI dashboard (5 cards)
The Eligibility overview page shows five KPI cards. Each card is clickable and drills into the filtered client list.
| Card | Shows | Filter logic |
|---|---|---|
| Needs Re-Auth | Priority action list | Seen in 90 days + coverage expired or expiring within 90 days |
| Covered & Active | Healthy clients | Active coverage + seen in last 90 days |
| Covered & Inactive | Untapped revenue | Active coverage + not seen in 91+ days |
| Stale Verifications | Overdue re-checks | Last eligibility check was 30+ days ago |
| Expiring in 30 Days | Upcoming deadlines | Active coverage + policy end date within 30 days |
Inline editing
Three fields can be edited directly in the client list by clicking the cell. Changes save immediately and propagate to all KPIs, filters, and reports across the platform.
Re-authorization workflow
The recommended daily workflow for your authorization team:
Who can access Eligibility
The Eligibility module is accessible to users with the ceo, admin, or support_staff account roles. All three roles have read/write access, including inline editing. Specialists and providers do not have access to the Eligibility module. Supervisors with company-level roles can also access eligibility data for their assigned team.