Setting up a payer connection for Denti-Cal

To use Eligibility Essentials or Pro requests to get insurance eligibility data from Denti-Cal, you must create a payer connection for that payer. The process to add a connection for Denti-Cal is different from how you add connections for other payers.

Note: Access to the Payer Connection Portal requires the "Payer Connection Portal" security right (in the "Insurance" category).

To add payer connections

1. On the Settings menu, under Production, select Payer Connection Portal.

   The Payer Connection Portal page opens.

2. Select the Denti-Cal Setup tab.

   

3. Enter the Billing NPI and PIN that are enrolled in the Denti-Cal Provider Portal.

4. Click (or tap) Save.

   Note: If the setup has been successful, "Enrolled" appears for Status.

   

   Your Denti-Cal requests will now use these identifiers to retrieve eligibility information.

Note: Denti-Cal responses are minimal in terms of the breadth of data they provide. However, the minimal information they do provide is still very valuable.

What to expect in the response:

• Plan Name

• Insurance Type

• Effective Date

• Plan Start and End Dates

• Provisions - All coverage details appear in this section and generally include the following:

  • EVC # - Eligibility Verification Confirmation

  • Scope - Full or Restricted Scope Coverage

  • SOC (Share of Cost) - True or False

  • Coverage Type - Such as Medicaid or QMB (Qualified Medicare Beneficiary)

  • Other Carrier Information - If applicable to the patient

  • Spend Down Remaining Amount - If applicable to the patient

What not to expect in the response:

• Deductibles and Maximums

• Frequency, History, and Limitations

• Orthodontics

• Coverage

• Benefit Notes

These sections will always indicate "No Information Provided".

Example of a Denti-Cal response: