Electronic Eligibility and Benefits
Electronic eligibility and benefit information allows you to electronically verify a subscriber's eligibility and benefits in real time (e.g. percentages, deductibles, maximums and limitations).
There are several options:
Retrieve Eligibility and Benefit Information from a Clearinghouse
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.
View Request History
Patient vs. Subscriber: Eligibility requests are for subscribers only. If a request is sent for a patient who is not the subscriber, then only subscriber benefit information will be returned. Benefits for subscriber and patient are typically the same, but sometimes begin and end dates are different. This can lead to confusion if a request is outside a subscriber's coverage dates, but within the patient's coverage dates, or vice versa. In effect, the patient plan may appear 'active' even though 'inactive', or 'inactive' when 'active'. Workaround: To determine if a specific service will be covered for a patient, send a pre-authorization electronic claim.
The electronic eligibility format has a way to send a benefit request for the patient instead of the subscriber, but this would be a Feature Request. Importing the benefit response is difficult. When the patient is not the subscriber, importing the response would sometimes require creating a new plan so that the subscriber's plan is not altered.
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:
Open Dental Software 1-503-363-5432