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Eligibility Essentials
and Pro

Real-time insurance verification right at your fingertips, helping your staff provide better service and patients feel more confident about their care.

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Overview

In today’s fast-paced dental practice, time is of the essence. Ensuring accurate insurance verification can be time-consuming and tedious, but it’s essential for smooth operations and patient satisfaction. That’s why we’ve developed Eligibility Essentials and Eligibility Pro—two powerful tools integrated directly within your trusted Dentrix platform.

Overview Video

How It Works

Eligibility Essentials and Pro are seamlessly integrated into the Dentrix platform, offering your dental practice real-time insurance verification that’s efficient and easy to use.

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Instant Insights

Eliminate accessing multiple portals or calls and reducing manual errors. Real-time verification provides uniform reports at yourfingertips.
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Unlock Advanced Data

Upgrade to Eligibility Pro for deeper searches with more payors and detailed data like patient history and frequency limits.
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Accellerate Acceptance

Understanding upfront costs increases treatment acceptance. Accurate eligibility checks speed up payments and reduce write-offs.

Eligibility Essentials

Eligibility Essentials makes it easy to access accurate insurance data from a wide network of payors, all within Dentrix. Get standardized benefit reports, color-coded status updates, and automated writebacks to coverage tables—all in one place. Save up to 20 minutes per eligibility check and free up your team to focus on patient care.

Eligibility Pro

Upgrade to Eligibility Pro and our advanced API goes beyond standard EDI by searching full insurance portals for you, pulling from more payors and more details such as patient history, frequency limitations, procedure-level coverage percentages, and network coverage. Pay as you go with no commitment or buy a package for a reduced rate per request.

Looking to optimize your entire revenue cycle?

Learn more about Revenue Cycle Management for faster claims processing and improved cash flow. Together, our solutions work seamlessly within Dentrix to keep your practice running smoothly, all while you focus on providing exceptional patient care.

How customers are succeeding with Eligibility Essentials and Pro*

63%

Percent change in satisfactory
eligibility responses

4

Numbers of staff hours
saved per day

10%

Average treatment plan
acceptance improvement

Survey data from 7 beta customers who used Eligibility Pro for an average of six weeks from July through August 2024. Data compared eligibility response results prior to beta test to those returned by Eligibility Pro.

Eligibility Pro has cut patient processing time in half Hygienists can check coverage instantly. and the confidence it brings has transformed our workflow. Returning to the old solution could cost me an employee! AmyBusiness Manager, Dawson Family Dentistry
Automating the process of pulling DNOA (Dental Network of America) insurance information is a significant improvement for us. DNOA is a payor we see often, and thisautomation has drastically reduced our time spent verifying on the phone. JasonOffice Manager, Hill-Davis Dental
I was surprised how much I appreciated seeing the green on the appointment book, knowing this patient's eligibility had been checked. BeckyOffice Manager, Mark L. Pettit, DDS

Frequently Asked Questions

Eligibility Pro goes beyond the basic EDI results by leveraging advanced API technology. When you set up your payors with their credentials or logins, our API securely logs in on your behalf and scans the full insurance portal. This deeper search retrieves a more comprehensive report, offering additional details like specialty codes, patient history, and frequency limitations. Essentially, it automates the manual process of navigating insurance portals, providing you with all the information you need, in one place, without the extra hassle.

Yes, Eligibility Pro can be accessed on-demand, with no commitment required. You can choose to pay per request or opt for a monthly package that offers a lower cost per request.

Eligibility Essentials

To access the new workflow, you will need to upgrade to Dentrix 24.16 or higher. If you are using Dentrix 23.4 or higher, you can turn on automatic updates. Otherwise, please schedule an upgrade with Dentrix Technical Support. 

If you have not sent claims through Dentrix in the last 30 days, you may need to verify your eTrans account. If you have sent claims in the last 30 days, you can skip this step. You DO NOT have to be an active user of eClaims to use Eligibility Essentials or Eligibility Pro.

Eligibility Pro

You will need to set up the Payer Connection Portal before you request an Eligibility Pro response for the first time. It is a quick process that gives Dentrix the necessary information to pull data from payor portals on your behalf.

We’re happy to provide more information or set up a demo to show you how Eligibility Essentials and Pro can benefit your practice. Contact our team today to schedule a demo or to ask any further questions.

Essentials has several key advantages:

  • Seamless workflow completely within Dentrix with no need to log into eCentral or use Insurance Manager for eligibilities.
  • More reliable responses, with fewer instances of data not being returned.
  • New color-coded eligibility status indicators that make it easy to tell why eligibility data is not available (E.g., Is the patient not covered? Does demographic data need to be updated?). In addition to color-coding, users can hover over the E for an explanation of the error.
  • Easy-to-read PDFs, standardized across payors, auto-saved to the document center, and accessible from the appointment book.
  • Staff can choose to have deductibles, maximums, and coverage percentages writeback to coverage tables.

Insurance Manager isn’t a part of the new eligibility workflow, but you can still use it to track claims and obtain eClaims reports. You will continue to use the previous eligibility workflow in Insurance Manager until you have upgraded to Dentrix 24.16 or higher.

Download complete FAQ document here

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