Insurance Verification

Insurance Verification automatically checks your patients’ eligibility, histories & frequencies, and full breakdown data prior to their appointments – right within the RevenueWell Marketing Platform system.

Instead of calling each insurance provider or spending time logging in and out of multiple insurance carrier portals, you can choose to perform a verification check within RevenueWell. Unlike a clearing house, RevenueWell’s Insurance Verification pulls data directly from the provider portals, so the data is more current and accurate. It’s data you can rely on and confidently share with patients.

    1. Let's first explore how Insurance Verification with RevenueWell works:

      1. Automated Verification: The system automatically verifies insurance four days before each appointment.
      2. Timely Results: Results are typically received within 24 hours.
      3. Comprehensive Verification Reports: For the initial appointment following the insurance renewal date, the system generates a comprehensive verification report in PDF format.
      4. Eligibility Reports: Subsequent appointments within the same year trigger the system to provide an eligibility report in PDF format, containing all necessary information for estimating costs.
      5. Verification Statuses: If there are issues with patient data or portal setup, this will be made clear with the patient verification status, allowing offices to rectify errors and rerun the verification if needed.
      6. Flexibility for Practices: Practices have the flexibility to categorize patients as "Self Pay" or manually verify them.
      7. Multiple Appointments: Insurance verification is conducted once for patients with multiple appointments, and the verification remains valid for 30 days. Offices have the option to manually rerun the verification, or its validity may be influenced by the policy end date.

      Understanding the logic behind insurance verification can streamline the process and ensure efficient handling of patient insurance information.

      1. Configure each insurance portal through the unified wrapper Settings (gear icon), now featuring a dedicated Insurance Verification tab with two key settings:

        • Carrier Settings

        • Multi-Factor Authentication Settings
      2. The system uses the practices own insurance carrier credentials to the insurance provider's portal to login and pull insurance information.

      3. All customers are required to complete initial configuration through the Onboarding Wizard.
    2. To complete your initial configuration: 
      1. Within RevenueWell, navigate to Settings by clicking on the gear icon.
      2. Select Insurance Verification settings.
      3. The Onboarding Wizard will pop up here.
      4. On the first page, you'll find a list of required information, including your top providers and the percentage of your patient base covered by each provider.
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      5. Entering Contact Information - Begin by inputting the necessary contact details to ensure seamless communication for carrier approval and multi-factor authentication.
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      6. Setting up Auto Self Pay - Choose insurance identifiers to automatically mark as Self Pay.
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      7. Starting Carrier Credential Setup - 
        • Here you will begin to enter information about your top providers.
        • These providers will be shown with the percentage of their patient base covered by the provider. 
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        • Adding Carrier Portal Credentials
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        • Define Provider Relationships - Our setup monitors the relationships with carriers at the provider level. The doctor assigned to the appointment will determine which relationship is utilized for verification. In this step you will define these provider relationships.
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        • Connect PMS Carrier to Credentials -
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        • Continuing Setting Up Credentials
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      8. Complete the steps above for each required insurance carrier. Upon completing the final provider, all information will be submitted for review.
      9. QA Review - Our partners, DentalRobot, will carefully review your setup to guarantee accuracy, completeness, and adherence to requirements. You will observe a pending approval screen while this process is underway.
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      10. Approval & Training - Upon approval, Insurance Verification data will seamlessly flow into your Appointments list within RevenueWell. Additionally, the RevenueWell Onboarding team will reach out to schedule a training session.

      If you encounter any challenges with the Insurance Verification Onboarding Wizard, feel free to contact our team for assistance by emailing accountprovisioning@revenuewell.com.

  • Settings
    • Practices can go to the Carrier Settings tab to add new carriers within their network.

      The percentage under the “Usage” represents the total percentage of your patients that use that insurance carrier. In the screen below, you can see that “Spirit”, who is out of network, accounts for 10% of your patients.

      When adding a new carrier portal:

      1. Select the “Add Carrier Portal” blue button.
        IVSettings1.png
      2. From there, you will be prompted to add:
        IVSettings2.png
        • Carrier Name
        • Portal URL
        • Carrier credentials
      3. Once the fields are completed, you must choose the Insurance Identifier to be shown under "Usage". Again, this identifier shows the percentage of patients with that insurance carrier.
        IVSettings3.png
    • In some cases, insurance carriers mandate multi-factor authentication (MFA). To facilitate this process, customers will be required to input a multi-factor contact that Dental Robot will utilize for calling and receiving the verification code.

      Take a look at some key notes on the MFA Settings page:

      1. Upon entering the MFA Settings section you are able to input contact information.
      2. The MFA Settings Page is where Dental Robot gets the MFA Code sent to the practice.
      3. RevenueWell suggests using a designated practice contact who will receive the MFA code.
        IVMFA.png
  • Running Verifications
    1. In our ongoing effort to phase out legacy systems, we are migrating vital elements from the legacy appointments tab to the "Appointments List" within Scheduler. 🎉

      When looking at the new appointment feature, users will now be able to see their patients for a given day day with their insurance status at a glance.

      IVAptTab2.png

    2. To download insurance reports for patients with verified insurance:
        1. Access the Scheduler app within RevenueWell.
        2. Open the Appointments List.
        3. Click on the download arrow next to the patient's "Insurance Verified" status.
        4. Navigate to your computer's "Downloads" folder.
        5. Select the newly downloaded Insurance Verification Report or Eligibility Report.
        6. Upload the chosen report to your PMS document center

      Comprehensive Verification Reports: For the initial appointment following the insurance renewal date, the system generates a comprehensive verification report in PDF format.
      Eligibility Reports: Subsequent appointments within the same year trigger the system to provide an eligibility report in PDF format, containing all necessary information for estimating costs.

  • Insurance Verification Statuses
    • The “Self Pay” status represents that status where a patient is paying out of pocket and not using insurance. This can be set manually through the interface on any patient. Since this is set manually a user can switch the status to manually verified or run verification if the data for insurance is present.
      IVStatuses2.png
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    • The “Manually Verified” status represents the case where the person in the office manually verified the patient and did not rely on the automated verification. This can be done on any patient regardless of state. If a person accidentally sets this we allow them to switch to self pay or run the automated verification.

      IVStatuses4.png
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    • The “Insurance Verified” status represents the case where the automated verification system was able to verify the insurance and provide an insurance report and if applicable an eligibility report. This state provides option to download the insurance reports that exist for this patient.IVStatuses6.png
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    • The “Insurance Inactive” status represents the case where the automated verification system
      determined the patient did not have active insurance based on the data in the system. This state provide the actions to move to self pay or to manually verify the patient.IVStatuses10.png
      IVStatuses11.png
    • The “Carrier Not Setup” status represents the cases where the insurance carrier attached to the patient is not linked to any credentials in the system. This case allows for the user to create a new credential for the carrier or link to an existing one.
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    • The “Data Missing” status represents the cases where the data needed to run verification is missing from the patient setup in the PMS.
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      patientdata.jpg
    • The “Verification in Process” status represents the cases where the automated verification system has been triggered but has not returned with the insurance verification results.
      IVStatuses17.pngIVStatuses18.png

        1. The user can wait at this point or move it either manually verified or self pay.
        2. If it is moved to these status and it the results come in they will not be able to access them.
    • The “Verification Unknown” status represents the case where we have not run the insurance verification process recently enough to consider the results valid (minimum an eligibility report in the last 30 days). This will show up only on appointments that are more than three days out because we run verification 3 days before the appointment.
      IVStatuses19.png
      IVStatuses20.png

    • The “Needs Attention” status represents the cases where the automated verification system what not able to validate the insurance due to invalid setup or missing patient data. For some use cases we offer the ability to correct that issue and rerun verification process. 

      These are use cases that trigger this status:

        1. Missing patient information required to run verification (re-run available)
        2. Insurance provider not setup(re-run available)
        3. Invalid credentials for the insurance provider portal(re-run available)
        4. Invalid URL for the insurance provider portal(re-run available)
        5. Unable to find patient
        6. Provider not supported
        7. Technical issue with provider portal
        8. Unknown…
          IVStatuses12.png
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  • Supported Carriers

    RevenueWell’s insurance verification solution collects data from 300+ carriers. This list highlights carriers that need additional information to ensure high-level data for your practice. This includes details like network name, portal details, and login credentials.

    Carrier Alternate Names Provider Portal Link
    AARP Dental Insurance Plan   https://www.deltadentalins.com/
    Aetna Aetna DMO https://www.dentalxchange.com/
    Aetna Aetna Medicare https://www.dentalxchange.com/
    Aetna Coventry Health Plan https://www.dentalxchange.com/
    Aetna Southwestern Bell Exec - Custom Care https://www.dentalxchange.com/
    Aetna Choice Plus https://www.dentalxchange.com/
    Aetna FlexCare https://www.dentalxchange.com/
    Aetna Mail Handlers Benefit Plan - MHBP https://www.dentalxchange.com/
    Aetna Marriott https://www.dentalxchange.com/
    Aetna Preferred Dental Organization (PDO) https://www.dentalxchange.com/
    Aetna Prudential Administered by Aetna https://www.dentalxchange.com/
    Aetna TWR https://www.dentalxchange.com/
    Aetna Varian Health Care Plan https://www.dentalxchange.com/
    Aetna Bell Atlantic https://www.dentalxchange.com/
    AFLAC   https://providerportal.aflac.com/
    AFLAC New York   https://providerportal.aflac.com/
    Blue Cross Blue Shield of Illinois   https://www.dnoaconnect.com/
    Blue Cross Blue Shield of Montana   https://www.dnoaconnect.com/
    Blue Cross Blue Shield of New Mexico   https://www.dnoaconnect.com/
    Blue Cross Blue Shield of Oklahoma   https://www.dnoaconnect.com/
    Blue Cross Blue Shield of Texas   https://www.dnoaconnect.com/
    Cigna Connecticut General (CIGNA) https://cignaforhcp.cigna.com/
    Cigna Continental Dental https://cignaforhcp.cigna.com/
    Cigna Equicor / Equitable https://cignaforhcp.cigna.com/
    Cigna Healthsource Provident https://cignaforhcp.cigna.com/
    Cigna Provident https://cignaforhcp.cigna.com/
    Cigna UFT Welfare Fund https://cignaforhcp.cigna.com/
    Cigna Banner Health and Dental https://cignaforhcp.cigna.com/
    Delta Dental of California   https://www.deltadentalins.com/
    Delta Dental of Colorado   https://www.deltadentalco.com/
    Delta Dental of Delaware   https://www.deltadentalins.com/
    Delta Dental Ins - Florida   https://www.deltadentalins.com/
    Delta Dental Ins - Georgia   https://www.deltadentalins.com/
    Delta Dental Ins   https://www.deltadentalins.com/
    Delta Dental of Idaho   https://www.deltadentalid.com/
    Delta Dental of Illinois   https://www.deltadentalil.com/
    Delta Dental of Indiana   https://dentalofficetoolkit.com/
    Delta Dental of Kentucky   https://dentalofficetoolkit.com/
    Delta Dental Ins - Louisiana   https://www.deltadentalins.com/
    Delta Dental of Maryland   https://www.deltadentalins.com/
    Delta Dental of Michigan   https://dentalofficetoolkit.com/
    Delta Dental of Minnesota 3M Dental Services https://dentalofficetoolkit.com/
    Delta Dental Ins - Mississippi   https://www.deltadentalins.com/
    Delta Dental Ins - Montana   https://www.deltadentalins.com/
    Delta Dental of North Carolina   https://dentalofficetoolkit.com/
    Delta Dental of Nebraska   https://dentalofficetoolkit.com/
    Delta Dental of New Jersey   https://www.deltadentalnj.com/
    Delta Dental of New Mexico   https://dentalofficetoolkit.com/
    Delta Dental Ins - Nevada   https://www.deltadentalins.com/
    Delta Dental of New York 32 BJ https://www.deltadentalins.com/
    Delta Dental of Ohio   https://dentalofficetoolkit.com/
    Delta Dental of Pennsylvania   https://www.deltadentalins.com/
    Delta Dental of Puerto Rico   https://www.deltadentalins.com/
    Delta Dental of Tennessee   https://dentalofficetoolkit.com/
    Delta Dental Ins - Texas   https://www.deltadentalins.com/
    Delta Dental Ins - Utah   https://www.deltadentalins.com/
    Delta Dental of Virginia   https://www.deltadentalva.com/
    Delta Dental of West Virginia   https://www.deltadentalins.com/
    Dentaquest Dentaquest - TennCare https://govservices.dentaquest.com/
    Dentaquest Dentaquest - University of Arizona Health Plans https://govservices.dentaquest.com/
    Dentaquest Dentaquest - WI State Employees https://govservices.dentaquest.com/
    Dentaquest Dentaquest - Affinity Health Plan https://govservices.dentaquest.com/
    Dentaquest Dentaquest - Atlantic Dental Inc https://govservices.dentaquest.com/
    Dentaquest Dentaquest - California Dental Network https://govservices.dentaquest.com/
    Dentaquest Dentaquest - Grady Healthcare https://govservices.dentaquest.com/
    Dentaquest Dentaquest - Maryland Physicians Care MCO https://govservices.dentaquest.com/
    Dentaquest Dentaquest - PhysiciansCare MCO https://govservices.dentaquest.com/
    Dentaquest Dentaquest - TrumanCare https://govservices.dentaquest.com/
    Dentaquest Dentaquest - Cimmaron Health Plan https://govservices.dentaquest.com/
    Dentaquest Dentaquest - Lovelace Community Health Plan https://govservices.dentaquest.com/
    Dentaquest Dentaquest - Presbyterian Salud https://govservices.dentaquest.com/
    Dentaquest Dentaquest - Xantus Health Plan https://govservices.dentaquest.com/
    Dentaquest Dentaquest - Medicaid of Virginia, HealthKeepers Plus https://govservices.dentaquest.com/
    Dentaquest Dentaquest - Medicaid of Nebraska https://govservices.dentaquest.com/
    Guardian Managed Dental Care Network https://www.guardianlife.com/
    Guardian Dental Guard Preferred https://www.guardianlife.com/
    MetLife Metropolitan https://www.metdental.com/
    SunLife   https://www.sunnet.sunlife.com/signin/provider/e/home.wca?
    United Concordia Florida Combined Life https://www.unitedconcordia.com/
    United Concordia United Concordia - Dental Plus https://www.unitedconcordia.com/
    United Concordia Blue Cross of PA - Highmark https://www.unitedconcordia.com/
    Unum Colonial Life https://unumdentalpwp.skygenusasystems.com/
  • FAQs

    What is the difference between using a clearinghouse, and RevenueWell Insurance Verification?  Clearinghouse data is often inaccurate 20%-50% of the time.  Our insurance verification pulls the benefits directly from the carrier portals through the practice login credentials.
    How fast does it take to receive verification of insurance and eligibility? The verification process can take only a few minutes, but it varies by carrier and in some cases can take up to 24 hours to receive notification. 
    Does RevenueWells Insurance product check if the policy is active and will it give us breakdowns for individual codes? Our insurance verification product provides you with the status of the policy and a breakdown of codes.
    How long is the office training for insurance verification?

    The practice will want to allocate 30-45 minutes for the initial training.

    Does RevenueWell Insurance Verification sync the patient data back to our practice management software?

    No. 

    If a practice resets a carrier password, does it break the IV carrier sync in MP?

    Sync breaks until password is updated in carrier settings. Verification returns "Credentials Invalid." Users see "Needs Attention" on appointment status, allowing them to correct and rerun. FAQimage.png

    What do I do if I cannot re-run a verification? In cases where a re-run isn't possible, Insurance Verification will provide customers with the following prompt: “We were unable to determine the certification status of this patient. You will need to contact the carrier directly to manually verify this patient or have them self-pay.”