A complete walkthrough of setup requirements, daily workflows, and troubleshooting for AutoEligibility, Denticon's automated insurance verification tool.

Verification Requirements

Before AutoEligibility can confirm eligibility and benefits, the patient's chart, subscriber information, and insurance plan must all include a few required details. Missing or incorrect data in any of these areas is the most common reason a verification fails.

Patient Record

Patient name
Date of birth
Address

Policy Holder / Subscriber

Subscriber name
Date of birth
Subscriber ID

Insurance Plan

Plan is attached to the patient's chart
Expected network type is displayed on the plan
A proper, supported electronic Payer ID is set on the attached carrier

NOTE ... If "Unknown" is selected as the network type, benefits will default to In-Network.

Network type and electronic Payer ID fields on an insurance plan.

Carrier Maintenance

A supported and accurate electronic Payer ID on your Denticon carriers is necessary for proper eligibility verification. DentalXChange sometimes uses slightly different Payer IDs than the ones printed on an insurance card, so the best practice is to verify the ID against the DentalXChange Payer ID list available inside Denticon.

Access the list: Help > Dental Carrier Payer ID List > search by name > Search.
Update Denticon: enter the DentalXChange Payer ID on the Denticon carrier and save.
Denticon confirms the Payer code against Real-Time Eligibility, Claim Status, and DXC Claim Attachment, and displays the result as Supported or Not Supported.

Payer ID support status on a Denticon carrier.

TIP ... Keep redundant carriers to a minimum. See We noticed duplicate carriers when adding an insurance plan. How can we remove the duplicate carriers from showing up for selection? – Planet DDS for how to clean up duplicate carriers.

GOOD TO KNOW ... The Payer ID is necessary to claims but does not automatically mean the payer is supported by DXC Eligibility AI. To check for supported payers, use this help link: What payers are eligible for AutoEligibility via DXC's Eligibility AI? – Planet DDS

Identifying and Attaching Insurance

AutoEligibility requires an active patient chart with an insurance plan attached, and that plan must have a valid electronic Payer ID and the correct network type listed. The plan can be an existing one already in Denticon, or a new placeholder plan.

A placeholder plan is a new plan built with default settings that will need to be updated later. It requires the patient's insurance carrier to be attached with the correct, supported electronic Payer ID.

BEST PRACTICE ... Keep a copy of the patient's insurance card and state ID in Denticon's Patient Notes section.

From the Patient Overview

Confirm the patient's last name, first name, and date of birth (DOB).
Click Primary or Secondary insurance.
- On the Add/Edit Dental Plan screen, search Denticon for an existing plan.
  - If found, attach the plan, then view the current insurance plan to check the network type listed on it.
  - If not found, add a new placeholder plan, entering the carrier, group number, employer, network type, and subscriber information, then save.

REMINDER ... The payer attached to the plan must be a supported payer for AutoEligibility to work — double-check this before moving on.

Add/Edit Dental Plan — searching for an existing plan.

Add/Edit Dental Plan — carrier and subscriber details.

Same-Day and Emergency Appointments

Same-day and emergency appointments are not supported by AutoEligibility. You should still attach an existing plan or add a placeholder plan for these patients.

To validate eligibility in these cases, use the Real-Time Eligibility (RTE) button within Denticon, or use DentalXChange to run a full benefits breakdown and history, then manually enter the results into Denticon.

SEE ALSO ... “New Eligibility Check — Manual Lookup” later in this guide for the full walkthrough.

AutoEligibility Results & Workflows

AutoEligibility runs a nightly sync against your scheduled appointments, plus a refresh of existing appointments every 15 minutes. To reduce delays, it's recommended that insurance is confirmed at least 24 hours before the patient's visit.

REMINDER ... Sync and refresh only run for future appointments — retro (past-date) syncing is not available.

Access: Utilities > AutoEligibility Verification

Understanding the AutoEligibility Page

Choose your appointment date, then click Review Eligibility.
Filter by eligibility status to view only specific statuses.
Sort by patient, provider, carrier, or primary/secondary.
Status — hover over the status to see any related messages.
Review/Update — click this link to view full eligibility details.

The AutoEligibility Verification page.

The Review/Update Link

The Review/Update screen compares Denticon's existing data (left) against the updated payer details (right). Fields shown in bold indicate a difference between the two. Select the accept box to apply a change, or leave it unchecked to bypass it. A blank field means no benefit information was returned, so the existing Denticon data stays unchanged.

NOTE ... This section is informational — it's meant to help you compare and decide — but you can still proceed with an update from here if the information checks out.

Patient Section (highlighted in yellow)

Carrier and Employer help confirm the right plan, but they don't carry as much weight as Group Number and Network Participation — those two must match.

Carrier — Helps identify the right carrier and fee schedule at the office level.
Employer — Denticon employer names distinguish plan variations, often used to show same group numbers with plan variances (Dell Technologies $1000 max vs $2000 max; Dell Technologies 100/80/50 vs 90/70/40).
Group Number — a mismatch means stop. Search Denticon for the correct plan, attach it (or add a new placeholder plan), then manually re-sync the appointment in DentalXChange.
Network Participation — a mismatch means stop. Search Denticon for the correct plan, attach it (or add a new placeholder plan), then manually re-sync the appointment in DentalXChange.

Benefit Information (highlighted in green)

Incentive-level plan balances may show a higher amount than the standard plan allowance.
Plan-level benefits update for every patient attached to that plan; remaining amounts update only for the individual patient.

Coverage and Limitations

Accepted bold data replaces the existing Denticon information.
After making your selections, click Update Plan.

Review/Update comparison view.

IMPORTANT ... Updating a plan affects every patient attached to it. A confirmation message shows the number of patients impacted, and this action is permanent — it cannot be reversed once completed.

Denticon Eligibility Icons

Eligibility status is visible in several places throughout Denticon.

From the Patient Overview

Hover over the eligibility status icon.

Hover over the Primary Insurance notes.

Within the Primary/Secondary Insurance Screen

On the Appointment Scheduler

View the appointment icon directly on the scheduler.

Status Workflows

GOOD TO KNOW ... Re-syncing is only available for future appointments. For patient history, plan notes, or individual code lookups, see “DentalXChange Navigation” later in this guide.

Eligible

Verify the group number. If correct, continue; if incorrect, stop and repeat the steps in “Identifying and Attaching Insurance.”
Verify network participation. If correct, continue; if incorrect, stop and repeat the same steps.
Review the coverage details. Review all bold information and accept as needed.
HMO and Medicaid/Medicare plans will only validate eligibility — other than a maximum and deductible, benefits may not display.
Review the maximum, deductible, and remaining amounts, then click Accept. Remaining amounts may vary based on procedures posted and claims pending with insurance.
Review frequencies and limitations, click Accept, then click Update Plan. If anything is incorrect, stop and repeat the insurance setup steps.

NOTE ... For any questions or concerns, submit a ticket to Denticon Support through the Help Portal.

Not Eligible

Click the patient's name to open the Patient Overview.
Archive the attached plan: click Primary, enter the patient's termination date, and save.
Click Primary again and change "Patient Rel to the Sub" to None.
Contact the patient for updated insurance information.
- For day-before or future appointments, allow AutoEligibility to process the update.
- For same-day or past appointments, submit a manual request.

Unknown

Hover over "Unknown" in the Eligibility Status column to view the message.
Follow the resolution guidance based on the message received — see "Common ‘Unknown’ Errors" below.

Common "Unknown" Errors

Workflow Message	Resolution Steps
Carrier mismatch	Determine whether the attached plan has the correct fee schedule. If applicable, edit the plan and update the carrier to the proper fee schedule, or add a new one.
Employer mismatch	Employers can separate same-group-number plans with different coverage levels. If applicable, edit the attached plan or add a new one.
Group mismatch	Important: do not update the plan — the plan attached is a completely different group. Follow the steps in “Identifying and Attaching Insurance” to find the correct plan.
Network Type mismatch	Important: do not update the plan — the level of benefits will change completely. Follow the steps in “Identifying and Attaching Insurance” to find the correct plan.
Patient could not be found	Confirm the Member ID matches the insurance card. Confirm the patient's name matches payer records exactly (spelling, spaces, hyphens), and that the date of birth matches payer records.
Subscriber could not be found	Confirm the subscriber/insurance holder ID matches the insurance card. Confirm the subscriber's name and date of birth match payer records exactly.
Provider NPI not on file (contact payer)	Confirm the provider's NPI is entered correctly and that the provider is contracted/credentialed with the payer. If it's still not found, contact the payer to confirm the NPI is on file and active.
Payer issues (not available, portal under maintenance, unknown portal error, not responding, network error, etc.)	Checks that fail due to temporary payer issues are automatically retried every 24 hours — no manual action needed. Errors that require user action (such as invalid or missing credentials) will continue to display so you can take the next step.
Process timed out	Use the manual re-sync option — timeouts are not automatically retried. Recheck the results after the re-sync completes.
Payer under maintenance	Confirm the payer is in a maintenance or outage window. Wait until maintenance is resolved, then run a manual re-sync.
Payer not supported	Confirm the Denticon Payer ID is correct. If the payer truly isn't supported, complete verification outside of AutoEligibility and manually enter the verified information in Denticon.
No payer match found (update Payer ID)	Confirm the correct Denticon Payer ID for this carrier, update it in Denticon, then perform a manual re-sync in DentalXChange.
Payer not registered on your payer portal	Register or enroll for the required payer portal (for example, Availity). Confirm registration is active and credentials work, then perform a manual re-sync in DentalXChange.

DentalXChange Navigation

Access

Denticon Utilities > eClaims Management > Eligibility > Eligibility AI > Administration

Daily Huddle

The Daily Huddle is the landing page for Eligibility AI, showing all scheduled appointments from Denticon — including discount, in-house, no-insurance, and standard insurance patients.

To access patient details, click on the name hyperlink.

The boxes at the top of the page show the number of patient records per verification status; clicking a box applies a quick filter. Column headers support additional sorting.

Verified — successful returns from the payer.
In Progress — requests still in process; no action needed.
Pending — the payer has not responded yet; no action needed.
Missing Data — the request was not sent to the payer; more data is required, or information needs to be updated in Denticon.
Error — the data does not match the payer's system; update the data and resubmit the request.

The Daily Huddle view in Eligibility AI.

Re-Sync

Re-sync is available but never applied automatically — you decide whether a request is valid for a re-sync. There are two common ways to trigger one:

By the patient's name, when data has changed between Denticon and DentalXChange.
Using the icon in the Actions column on the right. If no re-sync icon appears next to the patient's name, the action will simply re-run the existing data.

Patient History and Code Search

Path: Eligibility AI > Daily Huddle > click the patient name > Patient Plan > icons on the left.

Path: Eligibility AI > Daily Huddle > click the patient name > Coverages > Search.

Use this to search for an ADA code that wasn't part of the original request. Both in-network and out-of-network results are displayed.

New Eligibility Check — Manual Lookup

For same-day walk-ins or emergency patients, a manual lookup and entry is necessary. Click New Eligibility Check, enter the patient's information, then click Check Eligibility. If the payer isn't participating, follow your standard office process instead.

Supporting Articles

Need Help?

Submit a support ticket at any time:

support.planetdds.com/hc/en-us/requests/new
Phone: 800.861.5098
Planet DDS · www.planetdds.com