Be sure to verify patient eligibility before providing services to make sure you’ll receive the appropriate compensation. Use Provider Tools for up-to-date, unlimited eligibility and benefits information, including remaining maximums and deductibles.
Steps to verify eligibility:
- Log in and select Eligibility & Benefits. Enter the patient’s name and select Existing or New.
- For new patients: Enter the first and last name and date of birth. Then, select "Find Patient" for eligibility status and benefit details.
- For existing patients: You'll see the Eligibility & Benefits Summary first, followed by benefit and covered services, maximum and deductible amounts. Finally, you can find "other provisions" details for missing tooth clause, COB rules and more at the end of the page.
- Link to more details. Use the links in the sidebar to quickly access:
- Benefit Details: get benefit levels for procedures by category, such as Preventive, Restorative, Endodontics, etc.
- Benefit Search — enter up to 10 procedure codes, a keyword or a tooth number for more specific information.
- Treatment History — review benefit limitations and dates of service from claims we’ve paid from any dentist.
- Or use another great tool: My Patients. This tool lists your existing patients and their eligibility status. Select under Actions at the end of a row to open that patient’s Eligibility & Benefits Summary. Eligibility and benefits information is also available by using our automated telephone service.