Its great that Dentrix is now checking eligibility for Denti-Cal! It is also very important to receive the eligibility response message back into Dentrix. This eligibility message is key to seeing what kind of benefits they actually have. IE: They might have a Copay (Spend-Down, Share Of Cost), they might only have certain benefits, they might have a Primary PPO/HMO insurance, etc. Also, Eligibility is determined on a month to month basis(on the 1st), and gives an Eligibility Verification Code (EVC) for that month.
Example of an eligibility message: (Info redacted)
SUBSCRIBER LAST NAME: LASTNAME. EVC #: 999999XXX9. CNTY CODE: 37. PRMY AID CODE: T4. 1ST SPECIAL AID CODE: T1. MEDI-CAL ELIGIBLE W/ NO SOC/SPEND DOWN. HEALTH PLAN MEMBER: PHP-COMMUNITY HLTH GRP: MEDICAL CALL (XXX)XXX-XXXX. OTHER HEALTH INSURANCE COV UNDER CODE H - MULTIPLE PLANS COMPREHENSIVE. CARRIER NAME: UNITED HEALTHCARE HMO. ID: XXXX. CARRIER NAME: UNITED HEALTH CARE DENTAL. ID: XXXXXX. CARRIER NAME: UNITED HEALTHCARE VISION. ID: XXXXX. CARRIER NAME: OPTUM RX. ID: XXXXX. CARRIER NAME: UNITED BEHAVIORAL HEALTH. ID: XXXXXX. COV: OIM PDV.
Please return this String into the Note area of the Eligibility Status dialog box for a fully accurate eligibility evaluation for each patient.
Thank you
Brian Travers
Thank you for the comment. I see it there. Not a place i would have expected it.
Hi. The Denti-Cal eligibility response should be returning the EVC code on the PDF response.