Dentrix Ascend Eligibility Pro

To use Eligibility Pro requests to get enhanced insurance eligibility data, you must create payer connections.

To add payer connections

1. On the Settings menu, click the new option called Payer Connection Portal (under Production).

New Security Right: There is a new security right called “Payer Connection Portal” (under the “Insurance” category) that controls the availability of the Payer Connection Portal option on the Settings menu.

The Payer Connection Portal page opens on a new browser tab. Initially, there are no payer connections.

2. Click New Payer Connection.

The New Payer Credentials dialog box appears.

3. Select a Payer Connection.

Note: With a payer connection selected, a message appears, explaining that several payers are included under the umbrella of the selected payer connection.

4. In the Payer Username and Payer Password boxes, enter the credentials to access that payer’s online portal.

5. Click Save.

6. If the payer connection requires two-factor authentication, do the following:

a. In the Status column, click the corresponding Two-Factor Auth Required link.

b. Enter the code that the insurance company sends to you by email or text message, and then click Verify.

Note: If the payer connection has been successfully authenticated, its Status is “Connected.”

7. Repeat steps 2-6 as needed to add other payer connections.

Notes:

• If an authentication fails, click the corresponding Edit icon in the Actions column to open the Edit Payer Credentials dialog box and verify that the credentials you entered are correct.
• With a payer connection established, Dentrix Ascend attempts to get enhanced data from a payer. However, if the payer supports standard and enhanced data, to provide the most complete response possible, Dentrix Ascend attempts to merge the data from both sources according to the following criteria:
  • If the enhanced and standard data are available, Dentrix Ascend returns the enhanced and standard data.
  • If only the enhanced data are available, Dentrix Ascend returns only that data.
  • If the enhanced data are not available, Dentrix Ascend attempts to return the standard data.
• You are charged for an Eligibility Pro request only if it returns enhanced data.
• For payers (such as BCBSTX, Delta SD, and Delta OR) that support only Eligibility Pro requests, if an eligibility verification request fails, Dentrix Ascend returns a “Payer Not Participating” error.
  

Existing functionality of Dentrix Ascend allows you to enable or disable batch insurance eligibility verifications for a location (see “Enabling or disabling batch insurance eligibility verifications” in the Help) and allows you to specify the number of lead days (business days with appointments; based on the location’s hours) for eligibility verifications. The lead days are also used for batch Eligibility Pro verifications.

With Eligibility Pro, Dentrix Ascend verifies eligibility every three hours for patients with appointments that are scheduled for the next specified number of lead days, skipping patients whose eligibility has already been verified automatically in the current calendar month.

Note: Existing Dentrix Ascend functionality allows batch verifications nightly without Eligibility Pro.

Dentrix Ascend also verifies eligibility immediately after an appointment is scheduled today or for the next specified number of lead days. This is existing functionality; however, an Eligibility Pro request is now possible.

Important: Currently, on-demand Eligibility Pro requests are not available. However, standard on-demand requests are possible (see “Verifying eligibility statuses” in the Help).

Existing functionality of Dentrix Ascend allows you to view a standard response for an eligibility request (see “Viewing the eligibility status for an appointment” in the Help); however, an Eligibility Pro (enhanced) response is now possible.

To view insurance eligibility information for an appointment, click its “E” icon.

If a document that contains the patient’s eligibility information exists, the document appears.

Notes:

• Documents with eligibility information are stored in the corresponding patients’ Document Managers. This is existing functionality; however, enhanced data are now possible in those documents.
  
• The color of an appointment’s “E” icon varies according to the eligibility status (this is existing functionality):

 (Orange) – Unable to verify

 (Red) – Ineligible

 (Green) – Eligible