Electronic Eligibility and Benefits  

If you plan to use electronic eligibility and benefits, you should use Claim Connect as your default Clearinghouse.  You need to call them to make sure that you have both e-claims and "real-time" services enabled.  If both are not enabled, you will get an error message when attempting to connect.

In the InsPlan window, click the Request button at the middle of the window.

Double click on an item in the left column to see the individual benefit response.

Open Dental tries to interpret each raw benefit and to provide an equivalent Open Dental benefit object in the right column.  Any of these can be imported, but it still takes a human to interpret the data.  Most carriers still send very sparse data, frequently nothing more than single yes or no response on whether the patient is covered.

In order to improve the automation in Open Dental, we are interested in seeing any situations where Open Dental could automatically interpret the benefits better.  Especially long and complex responses.  If the carrier returns a percentage breakdown by category, Open Dental should be able to easily import those percentages.  If it can't we would like to see the response.  Feel free to email us 271 responses that will help us improve the automation.  We need more examples.    The raw 271 response is accessible at the upper right of the e-benefit window.

Some benefit types that Open Dental does not yet import include:
Addresses
Dates
Co-pays
Group names/numbers
Importing these types is considered a Feature Request. Our goal with this initial implementation is to get benefit information such as percentages, deductibles, maximums, limitations, and of course, eligibility.

All requests and responses are stored for future reference.  Click the History button in the InsPlan window.