Verifying eligibility statuses

You can use the Insurance Eligibility List to contact insurance carriers to verify eligibility of insurance coverage for patients with upcoming appointments.

Note: If automatic batch insurance eligibility verification has been turned on for your location, Dentrix Ascend verifies eligibility nightly for patients with appointments that are scheduled for the next four business days (days with appointments; based on the location's hours), skipping patients whose eligibility has already been verified automatically (either as part of a batch or individually) in the current calendar month.

To verify eligibility statuses

1. On the Schedule menu, click (or tap) Insurance Eligibility.

   The Insurance Eligibility page opens.

2. Navigate to the day or week of the appointments for which you want to verify eligibility.

   

   Notes:

   • Appointments are grouped by insurance carrier and then listed in chronological order.

   • You can view appointments for specific providers by selecting the desired providers from the View menu.

   • A patient's appointment appears on the Unable to Verify, Ineligible, or Eligible tab according to the eligibility status last specified for the patient, with the following exceptions:

     • If a patient has insurance, but eligibility has never been verified, his or her appointment appears on the Unable to Verify tab.

     • If a patient does not have insurance coverage because a plan has not been entered for the patient, the plan was removed from the patient, the patient's coverage has expired, or the appointment is outside of the coverage period for the patient's plan, his or her appointment appears on the Ineligible tab.

3. As you go down the list of appointments on each of the tabs, use the phone numbers displayed to contact each insurance carrier.

   

   

   

   Note: For each appointment, the date of the last verification of eligibility for coverage and whether the verification was done manually or automatically appear for your reference. This information does not appear if a verification was never performed.

4. For each appointment, do one of the following:

   • To automatically verify the patient's coverage and update his or her eligibility status, click (or tap) the Auto verify link. This link is available only if the insurance carrier accepts automated eligibility verification.

     Notes:

     • In the patient's record, the Eligibility status is changed accordingly, and today's date is entered as the Verification Date.

     • To view a document that contains the patient's eligibility and coverage details in response to the verification of coverage, click (or tap) the Eligibility Document icon next to the Auto verify link. The response document is stored in the patient's Document Manager with an "Eligibility" tag automatically.

     • To perform an automatic eligibility verification, your user account must have the "Create Carriers," "Edit Carriers," "Create Insurance Plans," and "Edit Insurance Plans" security rights enabled.

   • To manually specify the patient's eligibility status, contact the insurance carrier to verify coverage, and then do one of the following:

     • If the coverage could not be verified, click (or tap) Unable to Verify.

       Note: In the patient's record, the Eligibility status is changed to Unable to Verify, and today's date is entered as the Verification Date.

     • If the patient is ineligible for coverage, click (or tap) Ineligible.

       Note: In the patient's record, the Eligibility status is changed to Ineligible, and today's date is entered as the Verification Date.

     • If the patient is eligible for coverage, click (or tap) Eligible.

       Note: In the patient's record, the Eligibility status is changed to Eligible, and today's date is entered as the Verification Date.

   Note: If the Unable to Verify, Ineligible, and Eligible buttons are not available next to an appointment, the patient does not have insurance coverage because a plan has not been entered for the patient, the plan was removed from the patient, the patient's coverage has expired, or the appointment is outside of the coverage period for the patient's plan.

Tips:

• You can click (or tap) the time link of any appointment to go to that appointment on the schedule.

• You can click (or tap) the patient name link of any appointment to go to the Overview page of that patient's record.

• You can click (or tap) the name link of any insurance carrier to go to that carrier's website (if entered for that carrier).

• You can click (or tap) the name link of any insurance plan to go to that plan's website (if entered for that plan).