Denti-Cal is now a supported payer for Dentrix Ascend Eligibility Essentials and Pro. To start getting eligibility responses from Denti-Cal, you must specify your Denti-Cal NPI and PIN in the Payer Connection Portal.
To set up Denti-Cal in the Payer Connection Portal
1. Open the Payer Portal Connection by going to Settings > Payer Connection Portal.
Note: Accessing the Payer Connection Portal requires the “Payer Connection Portal” security right.
2. Select the Denti-Cal Setup tab.
3. Enter the Billing NPI and PIN that are enrolled in the Denti-Cal Provider Portal.
4. Click Save.
If the setup is successful, Enrolled appears for Status.
Your Denti-Cal requests will now use these identifiers to retrieve eligibility information.
Note: Denti-Cal responses are minimal in terms of the breadth of data they provide. However, the minimal information they do provide is still very valuable.
What to expect in the response:
- Plan Name
- Insurance Type
- Effective Date
- Plan Start and End Dates
- Provisions – All coverage details appear in this section and generally include the following:
- EVC # – Eligibility Verification Confirmation
- Scope – Full or Restricted Scope Coverage
- SOC (Share of Cost) – True or False
- Coverage Type – Such as Medicaid or QMB (Qualified Medicare Beneficiary)
- Other Carrier Information – If applicable to the patient
- Spend Down Remaining Amount – If applicable to the patient
What not to expect in the response:
- Deductibles and Maximums
- Frequency, History, and Limitations
- Orthodontics
- Coverage
- Benefit Notes
These sections will always indicate “No Information Provided”.
Examples of Denti-Cal responses:
