What is Enhanced Eligibility and how do we use it?

Description:
Denticon's Enhanced Eligibility tool allows your office to streamline patient insurance verification, powered by advanced DentalXChange Eligibility AI. This tool automates insurance verification, eliminating the need for time-consuming phone calls and manual portal navigation. With Enhanced Eligibility, your practice can increase efficiency, reduce errors, and enhance patient experience by ensuring accurate, up-to-date coverage information at every step. Offices using Enhanced Eligibility will no longer rely on the nightly RTE process to retrieve eligibility from DXC.

Key features: 

• Real-Time Eligibility Verification-Eligibility checks performed every 5 minutes for up-to-date insurance verification.
• Code Level Breakdown-Coverage & Limitation breakdown based on the insurance plan categories (per plan set-up)​.
  • Denticon sends appointment and patient insurance details, including a single representative code for each category​.
    • Example: D0120 sent for Diagnostic and D1110 sent for Preventative​.
• DentalXChange Real Time Eligibility (RTE)- Offices using Enhanced Eligibility will no longer rely on the nightly RTE process to retrieve eligibility information from DXC.
  • On-demand eligibility checks are still available via the existing ‘Check Eligibility’ feature on the Patient Eligibility Screen.

Prerequisites:

• Before go-live - office level credentials must be set-up for each payer within the DentalXChange Eligibility AI portal​.
• Patients must be attached to a plan to successfully complete eligibility verification with the partner.
• The following security rights will need to be assigned to users who wish to utilize the feature:
  • View Only- These users will only have access to view the Patient Eligibility Dashboard.
    • Utilities – Enhanced Eligibility Plan – View Only
  • Full Control- These users will be able to access the review/update plan screen and make updates to the plans. 
    • Utilities – Enhanced Eligibility Plan – Full Control

How to use:

Enhanced Eligibility Dashboard

1. Go to Utilities > Enhanced Eligibility Verification.
2. Select "Appoint Date". (Up to 3 business days in future)
3. Click "Review Appointment Date".
4. The page will display the eligibility status for all patients with appointments on the selected day for whom a verification attempt was made by DXC.
   1. If the eligibility status returns as "Unknown" hovering over the "Unknown" will display the error message returned from DXC.                           
5. Click on the eyeball icon in the Enhanced Eligibility Dashboard to view the view the returned Plan, Benefits, and Coverage & Limitations details returned from DXC.
   1. Note: only information returned from DXC displayed. The screen will include blank fields since they are not returned from DXC as part of the integration. Blank fields returned from DXC will NOT overwrite existing Denticon plan information for benefits, coverage and limitations.
   2. This details screen will always include the partner returned data and not reflect plan updates made by the user when clicking the "Review/Update" link.
6. The Enhanced Eligibility dashboard can be filtered by Plan Status, the dashboard will default to show "All".     
   1. There are 3 plan statuses:

      1. Pending Review- The review/update plan has not been completed.

      2. Plan Updated- The review/update completed.

      3. Unable to Verify- DXC was unable to verify the plan.  

7. Clicking the "Review/Update" link on the Enhanced Eligibility dashboard will launch the "Enhanced Eligibility Review" screen.
   1. The left side of the page presents the existing plan details in Denticon and the right side shows the data for benefits, coverage, and limitations returned from DXC. 

   2. The user is able to select "Accept All" or select "Accept" at the individual category level, then click the "Update Plan" button. 

   3. A pop-up will be presented informing the user of the number of patients attached to the Plan.

   4. Click "OK" or "Cancel".

   5. If "OK" is selected, the Denticon plan will be updated (Insurance Plan Setup) and the patient’s remaining benefits will be updated.  

Viewing eligibility status in Denticon

Outside of the Enhanced Eligibility dashboard there are several places in Denticon where you can view a patient's insurance eligibility status.

1. Patient Overview Screen
2. Scheduler                                                                             
3. Patient Insurance Plan Details Screen

Best Practices:

• For more detailed benefits retrieval, refine plan categories to separate procedures with different limitations (e.g., Full Mouth X-rays vs. Bitewings). The more granularity you have in your categories the more precise the plan detail will be.
• It is recommended to have minimal duplication of carriers and plans in your current Denticon insurance plans setup for optimal accuracy and workflow efficiency.​ 
  • We noticed duplicate carriers when adding an insurance plan. How can we remove the duplicate carriers from showing up for selection?
  • We noticed duplicate carriers when adding an insurance plan. How can we remove the duplicate carriers from showing up for selection?

Additional information:

Denticon allows for code level exceptions for an individual plan without having to create categories. At this time Enhanced Eligibility does not support single code level exception for the Enhanced Eligibility process. The existing coverage and limitations for single code level exceptions will not be updated.

How do we setup our office for Enhanced Eligibility? (Currently in Beta)

What payers are eligible for Enhanced Eligibility via DXC's Eligibility AI? (Currently in Beta)