Electronic Eligibility and Benefits

Eligibility requests retrieve benefit information from a Clearinghouse.

In the Insurance Plan window, in the middle, click Request.

Electronic eligibility and benefit information allows you to electronically verify a patient's insurance eligibility and benefits in real time (e.g. percentages, deductibles, maximums, limitations, and history). Non-subscriber benefits that are not identified as family coverage are inserted as patient override benefits.

Electronic Eligibility checks can be run as a batch by creating a Scheduled Process.

The following third-parties are known to offer eligibility services:

Dates

The Dates grid shows information on eligibility and active service dates.

Miscellaneous Options

Viewing Mode: Select how to view the response message. Options are Electronic Import or Message Text.

Mark for import if: Select whether benefits for In Network or Out of Network should be imported. Dependent on your disposition with the carrier.

Show Raw Message of...:

Print: If there are HTML responses, view and print the HTML. Otherwise, the main grid is printed.

Reponse Benefit Information

This grid displays benefit details received from clearinghouse.

Columns:

Import Benefit Coinsurance:

Current Group Num: The entered group number on the selected patient. A red warning will display if this does not match the group number reported by the carrier below.

Response Group Num: The group number returned by the carrier.

Import: Highlight benefits from the grid, then click to import benefits to the patient's plan.

Current Benefits

This grid lists current benefits entered in on the selected patient's insurance plan.

Note

Use the note box to record notes as desired when importing benefits.

Delete: Delete the response.

Setup

  1. Register with the vendor. If a clearinghouse, make sure Real Time Eligibility or real time services is enabled.
  2. Enable the vendor in Open Dental.
    • If a clearinghouse, set the clearinghouse as your default dental clearinghouse.
    • If Trojan, enable the bridge. Then click Trojan on the Edit Insurance Plan window.
  3. Verify that each carrier's electronic ID is entered accurately in Open Dental (Insurance Plan or Carriers). To determine a carrier's electronic ID, check with the clearinghouse.

View Request History

On the Edit Insurance Plan window, click History. All requests and responses are stored for future reference.