Patient Eligibility at a Glance

Learn how to quickly verify patient insurance eligibility from Dentrix.

Does your office staff spend a lot of time on the phone with insurance companies checking patients’ eligibility for insurance benefits? Do you wish there were a quicker and easier way? If you answered “yes” to both of these questions, maybe you haven’t heard about the patient eligibility features of Dentrix and eCentral.

The eCentral Insurance Manager integrates with Dentrix, automating many of your routine communications with insurance payors and conveniently displaying eligibility information in the Appointment Book and Family File. By automating the time-consuming task of verifying insurance eligibility, your front office staff will spend less time on the phone with insurance payors and more time with patients and other office responsibilities. Additionally, by verifying insurance eligibility before a patient’s visit, your staff will be more prepared for the appointment and better able to discuss treatment options. Since affordability is one of the barriers to case acceptance, knowing a patient’s insurance eligibility status can help you plan your case presentation and prepare to offer appropriate patient financing options. Working together, the eCentral Insurance Manager and Dentrix can help you save time and money.

Getting Ready to Use the Insurance Eligibility Feature

Not all payors offer real-time insurance eligibility information. If you want to find out if a particular payor provides electronic insurance eligibility verification, visit Under Payor Search Engine, type a payor ID or name, and then click Find Payors. In the list of matches that appears, you’ll see an X in the ELG column beside the names of payors who provide real-time eligibility information.

You can also view a list of participating payors when you are logged into your eCentral account. Point to the Insurance tab, and then click Patient Eligibility. Next, click the Payor List link in the upper-right area of the Web page to view the list.

Before you can get real-time patient eligibility statuses in Dentrix, you must have an eCentral account, be registered to receive eligibility responses through the eCentral Insurance Manager, have eSync 2.7.7 or newer installed, and have Dentrix G4 with Productivity Pack 7 or later installed. After these pre-requisites have been met, complete the WebSync Wizard setup, which allows you to schedule insurance eligibilities to be updated at the same time every day for patients coming in the next day.

Updating Insurance Eligibilities for Scheduled Patients

Before you can have insurance eligibilities updated automatically, you must set up the WebSync Wizard. From any of the main Dentrix modules, click the DXWeb button on the toolbar  to open the DXWeb toolbar, click the Settings button, click WebSync Wizard to start the wizard, and then set up the options in each section. In the WebSync portion, under WebSync Options, select Correspondence Upload and Insurance Eligibility Upload. When you get to the Insurance Eligibility portion, under Appointments in Range, set the appropriate time range. And after you have gone through all the options in the wizard, make sure you click Finish to save the changes.

The next time you perform a Web sync, the insurance eligibilities for all patients with appointments in the specified time range (from the WebSync Wizard setup) will be updated.

Viewing an Insurance Eligibility Status

You can view a patient’s insurance eligibility status from the Eligibility icon in the Insurance block of the Family File and in the Appointment Information dialog box, which can be opened by double-clicking an appointment in the Appointment Book. The color of the Eligibility icon indicates the patient’s eligibility status. A blue E on a white background  indicates that the patient is eligible for benefits. A gray E on a yellow background  indicates one of the following:

  • The patient’s eligibility is questionable (for example, some subscriber information was missing, or an invalid NPI number was used). F or an eligibility status other than “Eligible,” payors can use any of over 40 distinct statuses to indicate information is missing or invalid.
  • The patient’s eligibility has not been checked or entered manually from the Eligibility icon during the past five days.
  • The patient’s eligibility has never been checked or entered.
  • The patient doesn’t have insurance.
  • The patient has insurance, but his or her insurance company does not supply eligibility information through eCentral.

Also, you can position your pointer over the Eligibility icon if you want to view a tooltip with the status and date from the last eligibility check.

Requesting Insurance Eligibility for One Patient

In cases where the eligibility information for a patient may not be current (for example, because you haven’t run a Web sync recently), you can request the most current eligibility information. To do this, from the Insurance block in the patient’s Family File or from the Appointment Information dialog box (accessed by double-clicking the patient’s appointment in the Appointment Book), right-click the Eligibility icon, and then click Request Patient Eligibility via eCentral. The Patient Eligibility page of the eCentral website opens in a Web browser window. The patient whose eligibility you are checking appears as the first name on the list, and an eligibility status is displayed in the Response column.

Note: Some submissions may take up to one business day to process. This is a limitation imposed by the clearinghouses and payors that don’t fulfill eligibility requests in real time.

Viewing Insurance Eligibility Details

The amount and type of available eligibility information varies widely by insurance company. There can be an eligible or ineligible status and date or any number of details, such as provider information, subscriber information, coverage percentages by procedure, deductibles and maximums, and limitations.

To view details regarding a certain eligibility check, from the Insurance block in a patient’s Family File or from the Appointment Information dialog box (accessed by double-clicking a patient’s appointment) in the Appointment Book, right-click the Eligibility icon, and then click View Eligibility Detail Document to open eCentral and view the eligibility details in a new Web browser window.

If you want to send the report to the patient’s Document Center, click Add to Patient’s Document Center.

In conclusion, by effectively automating the task of verifying insurance eligibility and providing a method to check patient insurance eligibilities in real time, Dentrix can save you time and money and help you be better prepared to discuss treatment options with patients.

Learn More

To learn more about setting up and using the patient eligibility feature, see the Checking Insurance Eligibility topic in Dentrix Help and the Patient Eligibility and Insurance Eligibility Setup topics in the eCentral Help.

By Gentry Winn, Contributing Editor

Dentrix Magazine Volume 22 Issue 3 – Fall/Winter 2010