Eligibility and Benefit Verification

Not all patients who are coming for hygiene appointments have active insurance coverage. For that, the dental clinic needs to make sure that the patients coming for hygiene treatment have active and complete breakdown plans or covers. It takes quality man-hours to collect and record all findings. Astron EHS takes responsibility of obtaining the active coverage and breakdown benefits of New and Existing patients in a highly efficient manner. The deep industry knowledge and cutting-edge technology enable us to record the eligibility and full benefit breakdown in a timely manner.

 Verification Sevices;
Our expert teams will call insurance companies and trace all findings on the benefit verification sheet for new and existing patients.

We provide 3 types of verification window that include,

Next Day Verification: The recorded report of the next day verification will be sent right back to the patient’s PMS before one day of the appointment.

Same Day Verification: The full benefit breakdown will be posted to the PMS within 2hrs

Future Verification: All obtained coverage and breakdown evaluation will be sent two days before the appointment

Plan Creation or Evaluation (Group benefit administration in the PMS)

It will be the responsibility of Astron EHS to create the new employer or group plan corresponding to the benefit obtained from the insurance, following the office instructions. If the plan is already available in the PMS, Astron EHS will update the plan as per the instructions provided by the office.

Breakdown Forms

Astron EHS will process the verification on the Customized Breakdown forms provided by the offices.

  • Full Form: (For the PPO and Indemnity policies and the New patients)
  • Short Form: (For the existing patients with the PPO and Indemnity policies)
  • HMO/ DMO Form: (For the patients with the HMO/ DMO policies)
  • Specialty Forms: (for the patients who will be seeing the specialist; Endodontic, Periodontic, Oral Surgery, Orthodontic, etc.)

Source of Verification

Astron EHS will use various sources to obtain the benefit of the patients. Those are

  • Verification over the phone
  • Verification from insurance website (the offices will provide the website credentials)
  • Verification from fax received from insurance
  • Verification from the insurance IVRU (Interactive Voice Response Unit)

Reporting Structure of Astron EHS

Same Day Verification

The status will be shared with the office instantly.

  • If the Family File is not created Astron EHS will create the plan on test account in the PMS and will share the same with the office. Once the same has been created, office will have the instant plan to attach to the respective patient’s family file.
  • If the “Document Center” or the “Case Note” (the module in PMS where the patient’s breakdown is pasted) is not available, Astron EHS will share the breakdown via email with the offices. Once the same is created, the offices can paste the instant breakdown the module.

Next Day Verification

The status will be shared with the office at the end of the day, for all the appointments of the next day. For example:

  • On Monday: The report of Tuesday will be shared at the end of the day.
  • On Tuesday: The report of Wednesday will be shared at the end of the day.
  • On Wednesday: The report of Thursday will be shared at the end of the day.
  • On Thursday: The report of Friday will be shared at the end of the day.
  • On Friday: The report of Monday will be shared at the end of the day.

Future Verification

The status will be shared with the office at the end of the day, for all the appointments of the +2 days. For example:

  • On Monday: The report of Wednesday will be shared at the end of the day.
  • On Tuesday: The report of Thursday will be shared at the end of the day.
  • On Wednesday: The report of Friday will be shared at the end of the day.
  • On Thursday: The report of Monday will be shared at the end of the day.
  • On Friday: The report of Tuesday will be shared at the end of the day.