Electronic Eligibility and Benefits
Eligibility requests retrieve benefit information from a Clearinghouse.
In the Insurance Plan window, in the middle, click Request.
There are several options, including:
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 for that purpose.
Dates: This grid shows information on eligibility and active service dates.
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...:
Response Benefit Information: Grid of benefit details received from clearinghouse.
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: Click to import selected response benefits to the patient's plan.
Current Benefits: A list of current benefits entered in on the selected patient's insurance plan.
Note: Use to record notes as desired when importing benefits.
On the Edit Insurance Plan window, click History. All requests and responses are stored for future reference.
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.