EARLY ACCESS ONLY
After a patient has provided subscriber and insurance information on an online form, if there is a plan in your Dentrix Ascend database that matches the group number entered on the form, and if there is a patient in your Dentrix Ascend database that matches the subscriber name entered on the form, on the Insurance Information page for the subscriber and the patient (if he/she is not the subscriber), the insurance plan is added to both records as long as no active primary or secondary plans exist in the patient’s record.
Minimum required data:
Certain subscriber and insurance plan information must be entered on the form to determine if a plan can be automatically attached:
- Subscriber – At least two of the following: first name, last name, and birth date.
- Insurance plan – At least two of the following: carrier name, plan name, and group number.
Note: If the form is missing the minimum required data for either the subscriber or the insurance plan, automatic attachment is skipped (a blue notification appears).
Subscriber:
The subscriber can be the patient (self) or someone in the same household as the patient (possibly the guarantor).
Note: For a primary or secondary insurance plan, if the relationship to the subscriber is set to “self” on the form, the patient is set as the subscriber (subscriber matching is skipped).
Insurance plans:
The form received can have primary and secondary insurance plans for the patient. Dentrix Ascend compares the plans on the form to the plans in your organization’s database to attempt to find matches.
Notes:
- If primary insurance plan information is entered on the form, plan matching is attempted only if the patient does not have active primary or secondary insurance plans.
- If secondary insurance plan information is entered on the form, plan matching is attempted only if the patient does not have active primary or secondary insurance plans.
Match confidence:
Based on the subscriber and insurance plan information entered on the form, Dentrix Ascend assigns a score for each field (from zero up to a maximum that varies by field; allowances are made for typos and partial matches).
- The sum of the scores for the subscriber fields determines the confidence level of a subscriber match (confident, likely, possible, unlikely, or not a match).
- The sum of the scores for the insurance plan fields determines the confidence level of a plan match (confident, likely, possible, unlikely, or not a match).
If there is a confident match for the subscriber and a confident match for the insurance plan, the automatic attachment can occur as applicable.
Coverage/coordination order:
- The coverage order (primary or secondary) of an insurance plan on the form received applies to the patient.
- The coverage order of an insurance plan for the subscriber (if he/she is not the patient) may be different from the coverage order of that plan for a dependent.
Plan attachment order:
In Dentrix Ascend, a subscriber must be associated with a plan before a dependent patient can be linked to that subscriber and plan. The following steps are taken in order:
1. Resolve subscriber – If the subscriber is “self” on the form, skip subscriber matching, otherwise, attempt subscriber matching.
2. Resolve plan – Attempt insurance plan matching.
3. Check patient’s coverage:
- If a primary insurance plan is entered on the form, and if no active primary or secondary plan is attached to patient’s record, make sure subscriber and plan are confident matches. Otherwise, do not attach the plan to the subscriber or patient (skip the remaining steps).
- If a secondary insurance plan is entered on the form, and if no active primary or secondary plan is attached to patient’s record, make sure subscriber and plan are confident matches. Otherwise, do not attach the plan to the subscriber or patient (skip the remaining steps).
4. Subscriber (not same as patient) and plan:
- For the primary plan on the form:
- If a matching plan is already attached to the subscriber’s record (regardless of the current coverage order), use that plan as-is (the coverage order does not change).
- If a matching plan is not attached to the subscriber’s record, add the plan in the next available coverage order slot.
- If a matching plan is already attached to the subscriber’s record (regardless of the current coverage order), use that plan as-is (the coverage order does not change).
- For the secondary plan on the form:
- If a matching plan is already attached to the subscriber’s record (regardless of the current coverage order), use that plan as-is (the coverage order does not change).
- If a matching plan is not attached to the subscriber’s record, add the plan in the next available coverage order slot.
- If a matching plan is already attached to the subscriber’s record (regardless of the current coverage order), use that plan as-is (the coverage order does not change).
For example, if the form has primary and secondary plans, but the subscriber has a non-matching primary plan attached to his/her record, the primary plan from the form is added as the subscriber’s secondary plan, and the secondary plan from the form is added as the subscriber’s tertiary plan.
5. Patient (dependent) and plan:
- Attach the primary plan from the form to the patient’s record as the patient’s primary plan (with the patient as a dependent on the corresponding plan attached to the subscriber’s record).
- Attach the secondary plan from the form to the patient’s record as the patient’s secondary plan (with the patient as a dependent on the corresponding plan attached to the subscriber’s record).
6. Patient (subscriber) and plan:
- Attach the primary plan from the form to the patient’s record as the patient’s primary plan (with the patient as the subscriber).
- Attach the secondary plan from the form to the patient’s record as the patient’s secondary plan (with the patient as the subscriber).
Notifications:
- A purple notification (indicating a plan was added) can apply to the plan for one coverage order while a blue notification (indicating a review is needed) can apply to the plan for another coverage order; in which case, you will see a purple and a blue notification at the same time. However, you will not see more than one purple or blue notification at a given time.
- If multiple form submissions are received, a notification for only the most recent submission appears.
Note: For additional information about blue notifications, see the release notes about the “Notification of a New Insurance Plan Form” feature.