Introduction to Eligibility AI

Eligibility AI is a platform from DentalXChange that empowers dental offices to verify eligibility and benefits for their patients. Our platform connects directly with the insurance payers to retrieve patient's benefits and list them in an easy to read and organized format. Utilizing an integration to your Practice Management Software, Eligibility AI can verify multiple patients across multiple payers at the same time, all without the office staff lifting a finger.

How it works

1. Appointments — Eligibility AI revolves around appointments. These are the patients coming into your dental office to receive care and determining the financial responsibilities is key to providing exceptional service. There are a few options when it comes to getting your appointments into Eligibility AI.
   1. Practice Management Software Integration — If your office uses one of our supported PMS's, your appointments will automatically be synced in from your server in realtime
   2. Manual Entry — You can enter your appointments in using direct data entry
   3. CSV Import — You can enter up to 100 appointments at a time using a pre-formatted CSV template which is easily downloadable from within Eligibility AI
   4. API Integration — For those with more advanced configurations, Eligibility AI has a full-service API for creating and managing appointments
2. Eligibility & Benefit Checks — Once your appointments have been added, Eligibility AI will start automatically running the eligibility and benefit checks one to ten days before the appointments. This happens completely in the background - when you come into the office each day, you'll have a new batch of appointments ready to review.
3. Exception Based Workflow — Long gone are the days of running eligibility checks one by one. With Eligibility AI, you can focus on just the appointments without a successful benefit check.

What this means is you have a one-stop-shop to pull all of your patient's eligibility/benefits for any given day no matter the insurance they have, saving your staff time and providing better patient care all the same time.

Overview

There are three main sections to the Eligibility AI platform: Daily Huddle Status, Patients, and Administration

Daily Huddle Status

The home page for Eligibility AI and where you'll likely spend most of your time reviewing appointments and eligibility details.

1. Calendar — This will let you select a specific date so you can check all the patients that have an appoint on that date.
2. Snapshot View — Displays a quick view for the eligibility pulls done for the date you choose in the calendar. Includes completed checks, in progress checks, pending checks, and any checks that could not be completed due to missing information or errors.
3. Filters — Easily find the appointments for the day you picked in the calendar
   Source: lets you filter between appoints pulled from your software's book or ones created manually in the platform.
   Clinic: lets you filter between various clinics if you have them setup in your software.
   Providers: will filter appointments by rendering provider.
   Status: will filter based on the the results of the check (verified, in progress, pending, error, failed, missing data.)
   Insurance Status: filter by the patient's returned eligibility status.
4. Appointments — This is where you will see all the appointments for the date you selected in the calendar. You will see the patient's name listed as a click-able link which will pull up the benefits that were run for the appointment. You can click on the eye action button to see an overview of the appointment, or the refresh action button to re-run that patient's check.

Patients

This section is where Eligibility AI will save the patient information from the eligibility checks that were previously run, allowing you to quickly re-run checks for any follow up appointments and view insurance status at a glance.

This section will list the patient and their DOB, the last provider who rendered services for them, last run eligibility check date, the payer that the check was pulled from, and the most recent eligibility status for that previously run check. Lastly you will also notice a "+" button on the right side which will allow you to quickly create a manual appointment for the selected patient.

Administration

This is the section where you will handle any setup required for the Eligibility AI platform. By default, you will be taken to the Schedule Settings portion of the administration section.

1. Schedule Settings — This is where you can configure the Eligibility AI platform to automatically pull eligibility for patients. Simply select the number of days before an appointment you would like the checks to be run, and the time that the eligibility platform will run those checks, and let the platform do the rest!
   You do not need to be logged into the eligibility platform to have the automated checks run.
   For most up to date benefit results, we recommend you set the days before appointment to "5" in the schedule settings. This ensures you have the most up to date details and gives your staff a few days before each appointment to resolve any errors.
2. Payer Credentials — In this section, you will add your usernames and passwords you have for the various insurance company portals. This is what will allow the eligibility platform to connect directly to the payer's system when it attempts to pull benefits.

   

   If there are multiple payers that use the same website, they will be all grouped together and you will only need to enter one username and password.
   Some payers may require Multifactor Authentication for their portals. Check out the Multifactor Authentication article for additional steps.
   Here you will see the payer the credential is for, the website being used for the eligibility checks, username and password for the payer's site, the date/time the credentials were last updated, and a number of action buttons.
   1. The Eye button will show the saved password for the payer's site.
   2. The Double Page button willow allow you to use those same credentials for a different payer
   3. The Pad and Pencil button will let you adjust the saved username and password for a payer's site
   4. The Trashcan Button will delete the saved credentials for a payer's site.
3. Provider Management — This is the portion of Administration where you will add the providers from your practice. This will allow Eligibility AI to request eligibility and benefits through the EDI system if you do not have credentials for a particular payer's site. You can set one of the providers to be used as the "default" for EDI checks. To add a provider, simply click on "new provider" enter their first and last name, NPI and TIN, and they are added.

   

4. Softwares — Here is where you can download the software necessary to connect your Practice Management Software to Eligibility AI. Our implementation team will guide you through this process during onboarding but it's always here in case you need it later on.
5. API Keys — This portion will allow you to generate an API Key to add to your software. Simply click "new API Key" and select your software to generate the key. It will be listed on this page. There are also action buttons on this page as well:
   1. The Eye button will display the API Key
   2. The Double Page button will copy the key to your clipboard
   3. The Trashcan button will delete the key
      Use caution when deleting API Keys. If you delete a key which is being used to sync your appointments from the PMS, you will need to contact DentalXChange support to reconnect your PMS.