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robertwagner16
Canine III

Integration with Insurance Companies for Benefits

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Is there any possibility to be integrated with Insurance companies to get patient's benefits? I know in PracticeWorks we can update the Bluebook... Is that the only way to keep track of different benefits besides going online or by fax to get the benefits? Our office has not been updating the Bluebook every time we get the Insurance payments back to us... Can we just start doing it or is there something we need to do? Just thinking of different ways to have electronic records rather than paper. 

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19 Replies
CS Dental Employee
CS Dental Employee

Re: Integration with Insurance Companies for Benefits

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With a subscription to Trojan, you can update the blue books of some insurance companies on a regular basis by simply downloading their updates.  

Another possible solution would be to subscribe to our electronic claims eligibility service and you can then check benefits for each patient as they come in.

 

jeremy.dempsey‌ do you have another suggestion?

CS Dental Employee
CS Dental Employee

Re: Integration with Insurance Companies for Benefits

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Have you looked at our ePostings service? While not all payers are participating in this, the list of those that do grows each day. This would automate the posting of your payments(while giving you control of how it posts) and updating your bluebook is part of the process. It provides the most benefit for large bulk checks from a few payers that cover a number of patients. Our eVerifications service is intended to quickly pull at a moment's notice the current eligibility status of the patient and any benefit details that a payer may return. This information can vary from payer to payer and also does not automatically update the Bluebook. 

kyabuki
Canine II

Re: Integration with Insurance Companies for Benefits

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We also use Trojan, the monthly cost runs $200-230.  It is setup so it searches for updates each morning and downloads them and installs them with one button.

mdunham
Premolar III

Re: Integration with Insurance Companies for Benefits

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How did you get Trojan to actually work correctly?  It was a nightmare for office.  We even tried the Dentifi service.    

Trojan only updates the percentages, thank goodness not the bluebook.    More often than not, the plan that was updated did not have the correct percentages added, or the Maximum was off, etc.   their ins verification was also incorrect many times.  I was constantly checking behind them or fixing issues and therefor stopped the service after many wasted months and conversations with their designers etc.   

Also, it did not pull sub-ids for ins companies which of course denote different benefits and are required to have if you want accurate tx plans, ledgers etc.   

Are you using Trojan or their Dentifi program?   How long have you been using?    As we left them,  we let them know they could have a valuable product

if they corrected things.   Perhaps they have done that?

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CS Dental Employee
CS Dental Employee

Re: Integration with Insurance Companies for Benefits

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Updating the blue book will update both the percentage and the UCR for each code that you update. For plans that you do not participate with this is enough and you can start doing it immediately with no set up.

 

For plans that you do participate with (PPO, HMO, DMO, Capitation, etc.), you want to set the plan up in code specific estimating (from the Employer/Plan screen) prior to updating the blue book. If you need more info on this, please let me know. debi.peterson@carestream.com

carolyn621
Canine III

Re: Integration with Insurance Companies for Benefits

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We have used Trojan in the past. Some aspects of Trojan were great and others not so. Our experience with Trojan was if the plan was not in Trojan's system, it could take longer for Trojan to provide the information than it would for our staff to get it and we would be charged additional fee for the info. 

We took ideas from Trojan to use the Yellow Stickies more - on a lot of our plans we have at least 15 yellow stickies. We created a systematic way for the stickies to be labeled and info put on them.

If the office or provider(s) are in-network then updating can be easier - notice I state easier - it will still take work. Create a "COPY FROM" for each insurance that is in-network and in each procedure code enter the network allowed amount. Because our office is out of network with a lot of insurance, we use the Blue Book to update.

For us, we found it best to work on plans looking ahead to what would we need to provide the best info. Sometimes we notified patients we would submit pre-d to get an idea for the level of coverage and the patient would always agree to allow us to do this. Most times we could get on the phone and the insurance representative would let us know if our fees were within the range - we find this to be successful.

sonyap
Premolar II

Re: Integration with Insurance Companies for Benefits

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Can you send me more information on this (or point me in the right direction to find it)?  Checking benefits via phone calls, faxes, and website for 5000+ patients is very time consuming - not to mention entering the information into the software once you find it.

sonyap
Premolar II

Re: Integration with Insurance Companies for Benefits

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Is there any way to subscribe to ONLY the electronic claims eligibility service?  (not eposting or eclaims)

Moderator
Moderator

Re: Integration with Insurance Companies for Benefits

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sonyap

Sonya,

yes the Eligibility check service is available separately from other services. you would need to speak to your sales representative about that.

- Johnathan