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cdamoney
Canine III

Incorrect eligibility for x-rays

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When checking eligibility with soft dent for x-rays we are getting information that suggest Bite Wings can be taken once per year. United Concordia has rejected some stating 1 per 18 months. There are also age limitations that are not listed. Just recently we have only been checking insurance's websites for more precise information. Why is this happening? How do we receive the information from the insurance company's for the eligibility function? We have had to write off $  because we we're mislead by the information on our software. How do we know if any other information may not be accurate. 

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CS Dental Employee
CS Dental Employee

Re: Incorrect eligibility for x-rays

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United Concordia recently changed their BWX benefits.

for adults, they will only pay once every 18  months and for children 2Xper year.

that should be reflected on the Eligibility Report.  If you have an example where you received conflicting information on the website vs the eligibility report, please send me an example.  Wendy.Potts@csdental.com

You can reach me after 1 PM today on cell (814) 241-2412 if you would like to review this

suzanne
Canine III

Re: Incorrect eligibility for x-rays

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Hi Jenny,

It sounds like you are saying that there is now a feature in Softdent that will automatically fill-in the details for each Insurance Plan, such as the frequency limits, age limits, and tooth limits.  Is that accurate?  We have been calling insurance companies and checking websites for years and filling in our own "rundown" form with the specific frequency/age/tooth limitations.  However, we do get discrepancies depending on which representative answers the phone at the insurance companies on a particular day.  For example, some of them will quote a "2 in 12 months" frequency, and others will quote a "1 in 6 months" frequency for the exact same plan.  Obviously this creates a huge problem if we've been mis-quoted.  If your eligibility and benefits are automatically populated in Softdent, do you find that it is mostly accurate?  And are you able to correct any details that are not accurate in Softdent?  

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cdamoney
Canine III

Re: Incorrect eligibility for x-rays

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LOL! NO Softdent does not automatically fill in this info.  We actually use the e-verify which is an eservices function that will bring up a separate page with insurance verification information returned fromt he insurance company.  Then we see put a note in each patients account under the "notes" section so that it shows up on the charting side for the hygienist/dentist.  We put notes such as "bw @ 18 mos" or "bw @ 6mos < 18 "pan@ 5 yrs." Our issue is that the info returned ont he everify for United Concordia is inaccurate and we have to go to the website for all those patients.  We keep a list of the plan groups though and keep notes so we don't have to ck every single pt every time.  We are a large practice running 4 dentists and 4 hygienists from 8am to 7pm mon-thur and fri 8-5 so we see at least 85-100 patients a day.  It is a ton of work to verify online. 

Update: I emailed my professional rep with the inconsistencies between the patient's everify and the website.  Response was " everify is for quick view and may never be as accurate as website when verifying benefits" So no help there in making sure the info we have on file is accurate through everify.  Gotta love the insurance companies!

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