Insurance Verification Configuration Guide

  • Insurance Verification seamlessly examines your patients’ insurance eligibility and delivers comprehensive data ahead of their appointments, all within the RevenueWell Marketing Platform system.

    Gone are the days of juggling calls to various insurance providers or navigating multiple carrier portals. With Insurance Verification, you have the option to conduct checks directly within RevenueWell, providing you with dependable data that you can confidently communicate to your patients.

    As you get started with Insurance Verification, here are some important terms to know:

    1. NPI (National Provider Identifier): A 10-digit unique ID assigned to healthcare providers in the U.S. to streamline electronic transactions like insurance claims.

    2. Payer: An entity responsible for processing and paying claims for healthcare services, including dental, such as insurance companies or government programs.

    3. Provider: Individuals or entities, like dentists or dental practices, delivering healthcare services covered by insurance plans.

    4. Defining a Relationship: Process by which a dental provider establishes a contractual or professional tie with a dental insurance payer, involving documentation submission.

    5. PMS (Practice Management Software): Software tailored for managing dental practices, covering tasks like appointment scheduling, billing, and insurance claims processing.


    Ready to streamline your verification process? Onboarding for Insurance Verification (IV) is designed for self-setup at your convenience. Here's a quick overview of how you can set up Insurance Verification:

    • Access Settings: Start by navigating to the Settings section within RevenueWell. You can do this by clicking on the gear icon.
    • Select IV Settings: Once in the Settings menu, locate and select your new Insurance Verification settings option. This is where you'll configure all the necessary parameters for IV.
    • Welcome Screen: When you first use Insurance Verification Settings, you'll see a "Welcome" screen. It lists necessary onboarding info like National Provider Identifiers (NPIs) and shows your providers by patient percentage.
      2024-04-25_08-30-11.png
    • Configuring Settings: To begin using Insurance Verification, it is required to configure all of your Insurance Verification settings. 

      This article serves as a comprehensive guide to walk you through each stage of the Insurance Verification onboarding process. By completing this process, you'll unlock the benefits of Insurance Verification with RevenueWell, streamlining your administrative tasks and enhancing efficiency.

  • Step 1: Payer Setup

    Let's get started!

    To begin the setup process for Insurance Verification, please follow the steps below:  
    1. Login to RevenueWell.
    2. Click the "Settings" gear icon. 
      2024-04-25_08-27-52.png
    3. Click "Insurance Verification" in the settings menu. 
    4. Welcome! Ensure you have the required information for each provider (50% patient coverage required at set up). 
      2024-04-25_08-30-11.png
    5. Multi-location offices will then see a list of offices within your organization and their current status. To begin onboarding, click on the pencil icon next to each office and continue with the steps below for each office.
      2024-04-25_08-28-53.png
    6. Click into the "Payer Setup" tab within your Insurance Verification settings. 
    7. Select "Edit" next to the payer to begin setup. 
      2024-04-25_08-30-36.png
    8. Here you will see a screen with three (3) options:
      1. Option 1: Setup Payer - Initiates the primary flow to set up a new payer.
        1. Attach identifier to payerID: Choose from the list the Payer and their corresponding PayerID associated with their Insurance Identifier.

          2024-04-23_14-56-42.png

          If a Payer in the list has already been set up, you will see "SELECT (EXISTING)." Choosing this option will link the insurance identifier to the previously set-up Payer.

        2. Define relationship(s): Define the default relationship with the Payer and any provider exceptions. Provider exceptions occur when a specific provider at the practice has a different relationship with the Payer than the practice itself. When adding a provider exception, select the provider from a dropdown menu and the applicable relationship type accepted by the Payer.

          2024-04-23_14-57-05.png

        3. Portal Credentials [Pro]
          • 3a: Add payer portal credentials (Pro supported portals only): If the Payer's provider portal is supported, the setup process continues with this screen. Enter username and password to connect the provider portal.
            2024-04-23_14-57-26.png
          • 3b: Portal URL and Username/Email Conflicts [Pro]: Potential conflicts may arise when an office must correct the Username/Email for a specific portal before providing their password and continuing.
            • "Username/Connection Exists" (blue) - Indicates when the Portal URL and the Username/Email match an existing connection. To proceed, the practice can choose the "Use Existing Connection" button or adjust the Username/Email.
              2024-04-23_14-57-43.png
            • "Connection Exists" (red) - Indicates a rare occurrence where the exact Portal URL and Username/Email combination exists outside the practice's organization. To move forward, you must correct the Username/Email.

              2024-04-23_14-58-23.png
          • Step 3c: Payer portal connection statuses [Pro]: Once portal credentials are submitted, the system attempts to connect to the portal, displaying one of the following statuses:
            • "Connecting" - Establishing connection to the portal.
              2024-04-23_15-02-32.png
            • "Invalid Credentials" - The username and password combination was invalid.
              2024-04-23_15-02-49.png
            • "Connected" - Successful connection to the provider portal. At this point, the Payer setup is complete (unless the Payer is Medi-Cal).
              2024-04-23_15-03-09.png
        4. Add payer NPI Override (Medi-Cal only): For Medi-Cal, two additional pieces of data, NPI Override and PIN, are required.
          2024-04-23_15-06-55.png

        Watch our demo video for setting up an insurance identifier as a payer here! 🎬

      2. Option 2: Link to Existing Setup - This enables you to associate this Insurance Identifier with an already established payer setup.
        2024-04-23_14-54-55.png

        Watch our demo video for linking an insurance identifier to an existing payer here! 🎬

      3. Option 3: Set as Auto Self Pay - Allows you to designate this insurance identifier for Self Pay.
        2024-04-23_14-55-12.png
    9. Repeat these steps for each payer you wish to connect to RevenueWell.
    10. Once you have complete payer setup, go onto "Provider Set Up."

    Watch our demo video for marking an insurance identifier as an indicator of self pay here! 🎬

  • Step 2: Provider Setup 

    To conduct insurance verification effectively, it's essential to input the National Provider Identifier (NPI) for each provider within the practice.

    To complete your provider setup: 
    1. Click "Provider Setup" in the Insurance Verification settings. 
    2. Enter the NPI for each provider. 
    3. "Save" changes.
      2024-04-25_11-11-18.png 

    For hygienists (providers), please select one of the primary doctor's National Provider Identifiers (NPIs) to input. For active office staff or office staff who are no longer with the practice, please select the NPI of an active practicing provider. Additionally, you can update this information in your Practice Management System (PMS) to ensure accurate and up-to-date records of providers.

    See our demo video for provider setup here! 🎬

  • Step 3: PMS Sync

    In the Insurance Verification Settings section, you'll find the "PMS Sync" tab, which allows for automated PDF writeback of insurance verification documents (provided your PMS supports this feature). Here, you can easily determine if the sync is active, view the designated user for PDF syncing, and identify the destination location.

    To see this:
    1. Click "PMS Sync" within your Insurance Verification Settings.
    2. Select "Edit."
      2024-04-25_11-13-22.png
    3. Toggle "Enabled" on/off. 
    4. Select the designated "PMS User" from the dropdown menu.
    5. Choose your desired "PMS Location" from the dropdown menu to dictate where PDFs will be saved.
    6. "Save" changes. 
      2024-04-25_11-14-19.png

    Check out our demo video for PMS sync settings here! 🎬

    Check out our resource "Patient Data Management Made Simple" for additional insights!
    button-new.png

  • Carriers [Pro]

    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/

     

  • Demo Videos

    View our demo videos below for additional guidance on every step of the onboarding process! 🎬

    • In this video we will dive into starting the onboarding process and setting up an insurance identifier as a payer. 

    • Check out this demo to see how to link an insurance identifier to a existing connected payer.

    • Watch this demo for a quick overview of setting up an insurance identifier as an indicator of auto self pay. 

    • See the video below for a tutorial of provider setup.

    • In this demo we will cover how to edit your PMS Sync settings.