Electronic Eligibility and Benefits

Eligibility requests retrieve benefit information from a Clearinghouse.

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

Clearinghouses with Electronic Eligibility Services

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.

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.

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.