Electronic Eligibility and Benefits

Eligibility requests retrieve benefit information for subscribers and non-subscribers.

On the Edit Insurance Plan window, on the middle right 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 and limitations). Non-subscriber benefits that are not identified as family coverage are inserted as patient override benefits.

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

Note: 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.

Clearinghouses with Electronic Eligibility Services

There are several options:

Setup

  1. Register with the vendor. If a clearinghouse, make sure Real Time Eligibility or real time services is enabled.
  2. If a clearinghouse, set the clearinghouse as your default dental clearinghouse. See Clearinghouses.
    Note: 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.

Technical Information

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 so we can improve the automation. Please contact technical support if you are willing to provide this information. The raw 271 response is accessible at the upper right of the Edit Electronic Benefit Request window.

Toggle between the Mark for import if... radio buttons to quickly mark all the in or out of network benefits for import. Only marked benefits will be imported when the Import button is clicked. Some benefit types that Open Dental does not yet import include:

Importing these types is considered a Feature Requests. Our goal with this initial implementation is to get benefit information such as percentages, deductibles, maximums, limitations, and of course, eligibility.

Troubleshooting

Error message: There is a problem with your benefits request. Check with your clearinghouse to ensure they support Real Time Eligibility for this carrier and verify that the correct electronic ID is entered.

Solution: Your clearinghouse may not support Real Time Eligibility for the carrier or the electronic ID entered in Open Dental for the carrier may be inaccurate.

Error Message: ...Error message received directly from Claim Connect: Deficient request - required data is missing.

Solution: Double check that all provider information in the Edit Provider window is entered correctly.