Online RealTime Eligibility & Benefits Checking

opensource · Post by **opensource** » Sat Oct 13, 2007 12:20 pm

Hello Team

Wondering if anyone is using a good service provider for 'online realtime eligibility & benefits checking' for various insurance carriers in CA (USA)

I did try out claimconnect service for this about one year ago but based on the feedback from the office staff, there is always a need to call the insurance providers since there is always some information that they are looking for which the online service does not provide.

Does anyone have a better experience. Is your office completely or even 90% operational using the online realtime eligibility / benefit service providers ?

Thanks in advance for sharing your ideas / thoughts / experiences. Of course, the ideal solution would be when Open-Dental can integrate this service

Cheers,

OpenSource

Jorgebon · Post by **Jorgebon** » Sat Oct 13, 2007 2:20 pm

Our experience has been similar, although we use another clearinghouse. The problem is that online eligibility only confirms that the patient is active in a plan, but it doesn't give any information on procedure eligibility. These are the procedures that have time limits like once every 6 months or once a year. So we have to use the phone anyway to see if the patient is eligible for those procedures. I don't know of any other way around this for now. There are some insurance companies that have their website set up to check on procedures (I think) but those are very rare.
Jorge Bonilla, DMD

Post by **jordansparks** » Sun Oct 14, 2007 12:57 pm

The X12 specification certainly allows for the carrier to pass all of this detailed information. Our database was designed to mimic the X12 fields to greatly ease the sychronization of this info. That's why the "benefits" section of each insurance plan looks so complex and is in its own window. It follows the exact structure of X12. So we've been trying to build in the automation for years. Likewise, all the carriers are trying to build the automation on their end. I can guarantee you that they waste enormous amounts of money having to staff the phones, and they would much rather have it automated. So we're all moving in that direction, but it's just a very big task. I think we'll see some good progress this year.

opensource · Post by **opensource** » Sun Oct 14, 2007 4:05 pm

Hello Dr. Sparks,

I could not agree more with you on moving in the right direction. Infact, at times, I feel you (opendental) is leading the way. Keep it up !!!

I just thought that with the framework that you have in OpenDental and the framework that is supported for submitting the various claims (such as claimconnect), we should be able to extend that framework to cover even the eligibility & benefits checking. I guess it is a matter of time before that happens...hopefully by end of 2008

Team : Please continue to post any other experiences / thoughts you might have on this topic. Thanks once again.

Cheers,

OpenSource

sparkly · Post by **sparkly** » Mon Oct 15, 2007 7:50 pm

opensource wrote: Team : Please continue to post any other experiences / thoughts you might have on this topic. Thanks once again.
Cheers,
OpenSource

i know this doesn't answer your question completely, but we've had luck with logging on to each ins co's website for our little "form." a LOT more detailed info is listed there. if we have to call, it's for one-2 things that *I* like to know that doesn;t routinely show up under plan details.
till everyone is on the same page and we can pull info into OD, that's the best solution we've found.