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.
There are several options:
On the Edit Insurance Plan window, click History. All requests and responses are stored for future reference.
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.
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.