Automatically adding insurance plans from patient forms

After a patient submits dental insurance information through an online form, it can take substantial manual effort, which could delay completion of the patient's insurance information to review the form submission, find the correct insurance plan in Dentrix Ascend, and attach it to the subscriber and dependents. To help alleviate some of that workload, after a patient submits dental insurance information through an online form, if Dentrix Ascend can identify the subscriber and insurance plan with high confidence, it attaches the insurance plan to the applicable subscriber and patient (if he/she is not the subscriber). This automation can reduce manual data entry (if a clear match for a subscriber and insurance plan exist), reduce the time and effort it takes to update patient records, and lead to faster insurance eligibility verification (if automated eligibility verification is enabled).

Notes:

  • This functionality is available only if you are using Dentrix Ascend Forms.

  • This functionality is available only through an online form that contains the newest "Dental Insurance Form" element. If a form has an "Dental Insurance Form" element that was added prior to the release of this functionality, to update the element to the newest one, you must remove it and then re-add it.

Automated form processing steps

Notes: This process does not create a new carrier, plan, or fee schedule from the form. It can only attach existing plans.

A received form is processed in the following order

  1. Check for insurance information on the form. The form received can have primary and secondary insurance plans for the patient. If the form contains insurance information, the information for each plan is evaluated to determine if the plan can be attached automatically.

  2. Resolve the subscriber. The subscriber for a plan can be the patient (self) or someone in the same household as the patient (possibly the guarantor). The subscriber on the form is compared to the patient records in your organization's Dentrix Ascend database if subscriber matching is attempted.

    • If the patient's relationship to the subscriber is "self" on the form, the patient is the subscriber.

      • Subscriber matching is skipped. Proceed to the next step.

    • If the patient's relationship to the subscriber is not "self" on the form, someone else in the patient's household is the subscriber.

      • If at least two of the following subscriber details are provided on the form, subscriber matching is attempted: first name, last name, and birth date.

        • If a confident match for the subscriber on the form is found in Dentrix Ascend, proceed to the next step.

        • If a confident match for the subscriber on the form is not found in Dentrix Ascend, automatic plan attachment is skipped (a blue notification appears).

        Note: The system compares subscriber details and assigns a confidence score to potential matches. Higher scores indicate a stronger match, helping ensure subscribers are matched accurately even when information is incomplete or contains minor differences. A subscriber is a confident match if the confidence score is high enough.

      • If the form is missing the minimum required data for the subscriber, automatic plan attachment is skipped (a blue notification appears).

  3. Resolve the plan. The plan on the form is compared to the plans in your organization's Dentrix Ascend database if plan matching is attempted.

    • If the following insurance details are provided on the form, plan matching is attempted: carrier name and plan group number.

      • If a match for the plan on the form is found in Dentrix Ascend, proceed to the next step.

      • If a match for the plan on the form is not found in Dentrix Ascend, automatic plan attachment is skipped (a blue notification appears).

      Note: A plan is a match if the carrier name matches exactly, the plan group number matches exactly, and there is only one plan with that exact carrier name and group number.

    • If the form is missing the minimum required data for the insurance plan, automatic plan attachment is skipped (a blue notification appears).

  4. Check the patient's coverage. The patient's record is checked for active insurance plans to determine if automatic attachment can occur.

    • If no active primary or secondary plans are attached to patient's record, proceed to the next step.

    • If an active primary or secondary plan is attached to patient's record, automatic plan attachment is skipped (a blue notification appears).

  5. Update the subscriber's coverage (if the patient is not the subscriber). Update the coverage for the subscriber if the subscriber is someone other than the patient. The coverage order of each of the subscriber's insurance plans may be different from the coverage order of each of the dependent's (patient's) insurance plans.

    • If a matching plan is already attached to the subscriber's record (regardless of the current coverage order), use that plan as-is (the coverage order does not change).

    • If a matching plan is not attached to the subscriber's record, add the plan in the next available coverage order slot.

  6. Update the dependent patient's coverage (if the patient is not the subscriber). Update the coverage for the patient if the patient is a dependent on the subscriber's plan. The coverage order of each insurance plan on the form applies to the patient.

    • Attach the primary plan from the form to the patient's record as the patient's primary plan (with the patient as a dependent on the corresponding plan attached to the subscriber's record).

    • Attach the secondary plan from the form to the patient's record as the patient's secondary plan (with the patient as a dependent on the corresponding plan attached to the subscriber's record).

  7. Update the subscribing patient's coverage (if the patient is the subscriber). Update the coverage for the patient if the patient is the subscriber. The coverage order of each insurance plan on the form applies to the patient.

    • Attach the primary plan from the form to the patient's record as the patient's primary plan (with the patient as the subscriber).

    • Attach the secondary plan from the form to the patient's record as the patient's secondary plan (with the patient as the subscriber).

Note: For information about reviewing insurance plans that get added from patient forms, see the topic about reviewing added insurance from patient forms.

Notifications

  • A purple notification indicates that a plan was added.

  • A blue notification indicates that a review is needed.

  • A purple notification can apply to the plan for one coverage order while a blue notification can apply to the plan for another coverage order; in which case, you will see a purple and a blue notification at the same time. However, you will not see more than one purple or blue notification at a given time.

  • If multiple form submissions are received, a notification for only the most recent submission appears.

  • Dismissing a notification requires the "Edit Ins. Plan for Patient" security right.

Notes: