Articles in this section

See more

Generate Pending Eligibility or Verification Report

Namitha Elizabeth Smart
  • Updated
Follow

The Pending Eligibility or Verification Report is intended to view patients with upcoming appointments whose insurance plan or eligibility needs to be verified. The report can be used to review upcoming appointments with patients’ insurance either in draft or in eligibility pending status. 

This report shows real-time data. The report shows separate entries for primary, secondary, and tertiary insurance that the patient has.

The data captured is according to the date range specified. Only the appointments between the date that has insurance, either in draft or eligibility pending status, will be displayed. It will also show insurances that did not have their insurance eligibility last completed before the specified number of days.

Competitor Reports

  • Insurance Verification List (Open Dental)

Use Cases

  • Track patients with upcoming appointments whose insurance eligibility or coverage verification is pending to avoid claim denials and treatment delays.

Let's get started!

  • Navigate to the System Menu > select Operational Reports under Insights.
  • Click the + icon on the left or the Generate Report button on the right for the chosen report.

Explore below to learn more about the desired views, filter criteria, and results.

Let's explore the filters:

No Filters Description
1 Date Range*

The pending eligibility report is dated by the appointment date. Select the date range to focus your report on patients with an upcoming appointment that falls within the selected date range and have had their insurance eligibility last completed before the number of days specified in the Days Since Last Eligibility filter.

*The default date range will be Today.
2 Location*

Select the location(s) to focus the report on the appointments in the selected location(s).

*By default, the location will be the user’s default location.
3 Provider Select the provider(s) to focus the report on appointments with the selected provider(s) as the primary appointment provider(s).
4 Insurance Status*

Select insurance status to focus your report on patient insurance that is either pending verification, pending eligibility, or choose to include all. 

*By default, All will be selected.
5 Insurance Type* Select the insurance type to focus your report only on dental insurance, medical insurance, or choose to include both. By default, All will be selected.
6 Carrier Select the carrier to focus your report only on the selected carrier(s).
7 Insurance Hierarchy Select Insurance Hierarchy to focus your report only on primary dental insurance, primary medical insurance, secondary dental insurance, and so on.
8 Patient Flag Select patient flags to focus the report based on the patients with the selected patient flags.
9 Patient Select patients to focus the report based on the selected patients.
10 Days Since Last Eligibility Choose whether to focus your report on patients with an insurance plan that last had eligibility completed within the last 30 days, 31-60 days, 61-90 days, 90+ days, or select Days Greater Than to specify a custom number of days.
11 Days Greater Than* Generate your report based on insurance plans that have been pending eligibility or verification for a number of days greater than the number specified here. This filter is available only when the Days Greater Than is selected in the Days Since Last Eligibility filter
12 Columns* Select the columns you wish to see in this report. By default, all the columns excluding appt notes will be selected.
13 Exclude Draft Insurances Select this option if you would like to exclude drafted insurance plans that have yet to be added and verified.

Once you have selected the desired filters, click on the Generate button to generate your on-screen report or Download Report As button to download your report.

Generation/Download Criteria

  • Due to data volume, reports with more than 5 Treatment Locations or a date range exceeding 1 Month will not be generated on-screen.
  • Reports meeting these criteria will be accessible in the Scheduled Downloads section.

Result 

Now, let's take a look at the results of the Pending Eligibility or Verification Report.

  • Patient Name: The name of the patient.
  • Patient ID: The system-assigned number used to identify the patient and their records. On clicking on the Patient ID, the user is taken to the patient's insurance page.
  • Patient D.O.B: The patient's date of birth as specified in their patient profile.
  • Subscriber Name: The name of the subscriber listed on the patient's insurance plan.
  • Subscriber ID/SSN: The subscriber's ID or social security number is used to identify the subscriber and their coverage.
  • Subscriber D.O.B: The subscriber's date of birth, which is used to identify the subscriber and their coverage.
  • Appt. Date: The date of the patient's next appointment.
  • Appt. Time: The time of day when the patient's next appointment is scheduled.
  • Appt. Notes: Any notes included in the appointment details.
  • Location: The short name of the location associated with the patient's next appointment.
  • Location Tax ID: The tax ID of the location in which the patient's next appointment is scheduled.
  • Scheduled Provider: The primary provider associated with the patient's next scheduled appointment.
  • Scheduled Provider NPI: The HIPAA-assigned National Provider Identifier number associated with the primary treatment provider of the patient's scheduled appointment.
  • Default Provider: The patient's default treatment provider.
  • Default Provider NPI: The unique National Provider Identifier (NPI) of the patient's default treatment provider.
  • Carrier: The carrier for the patient's insurance plan.
  • Carrier Phone No.: The phone number used to reach the insurance carrier (as entered in insurance details in your practice settings).
  • Carrier Website: The website used to reach the insurance carrier (as entered in insurance details in your practice settings)
  • Insurance Type: The type of insurance coverage, whether it is dental or medical.
  • Plan Name: The name of the patient's insurance plan as it is entered in your practice settings.
  • Plan Type: The type of insurance plan, whether it is PPO, Medicaid, Co-Pay, and so on.
  • Group #: The group number of the patient's insurance plan.
  • Hierarchy: The hierarchy of the patient's insurance plan.
  • Status: The current status of the patient's insurance plan, whether it is pending verification or pending eligibility.
  • Last Verified On: The date on which the insurance plan was verified.
  • Last Verified By: The user who last verified the insurance plan.
  • Last Eligibility Done On: The date on which eligibility was last completed for the patient's insurance plan.
  • Last Eligibility Done By: The user who last completed eligibility for the patient's plan.

If users in your practice cannot use this report, please ensure that the relevant permissions are enabled.

To enable Permissions for the Pending Eligibility or Verification Report:

  • Navigate to the System Menu > Practice Settings > Administration > Profiles.
  • Click Manage Permissions for the intended profile.
  • Select Insights.
  • Select the Generate Pending Eligibility/Verification Report option under Operational Reports to enable the permission.
  • Click Save.
  • On the Confirm Action modal that appears, click Yes to proceed.
  • A toast notification appears on the top right stating, 'Profile updated successfully'.

Practices can use this comprehensive guide to efficiently generate reports, explore various use cases, and apply the necessary filter criteria to generate the desired report. Following this guide will help you create reports quickly, understand the different views available, and customize reports to meet specific needs. 

Click here to explore the complete list of permissions and their descriptions.

Related articles