Zuub's Insurance Verification Breakdowns make it easy for your team to look at patient coverage and access the most critical data when you need it. Breakdowns are normalized and standardized across insurance payers.
Quick Links:
Breakdown Overview
Header Bar
Patient Information
Patient Action Bar
Summary Breakdown vs Full Breakdown
Coverage Summary
Procedure Benefits
Breakdown Overview
Header Bar
The header bar is fixed at the top of the page and does not scroll with the rest of the information. It includes the patient's eligibility status, individual benefits, individual deductible, insurance payer, and the latest verification date.
Patient Information
Patient information allows you to view the insurance carrier and patient-specific information (e.g., DOB, Member ID, Group ID) for verification. If the patient's insurance information has changed and you need to verify coverage quickly, you can update this section and click "Verify Benefits." Please be sure to manually update the information in your practice management software as well.
Patient Action Bar
- Network drop-down allows you to change the network.
- Save to PDF allows you to download a PDF of the breakdown.
- Verify Benefits initiates a verification for the patient.
Summary Breakdown vs Full Breakdown
Summary Breakdown
The Summary Breakdown provides a high-level overview of a patient's benefits. Your team will use this to quickly find information on the most common procedure codes, view coverage, and access recent treatment history. Essentially, this is your insurance breakdown sheet.
Full Breakdown
The Full Breakdown provides the most complete patient insurance plan data. It includes more patient, plan, and insurance company information. It also provides a detailed breakdown of the benefits, such as the maximums and deductibles.
Benefits Summary
The Benefits Summary gives a general overview of the patient's insurance benefits and treatment history. This is the view that you will work from daily. The benefits summary will give you the most common information needed for your patients.
Patient & Plan Information
The benefit summary includes patient information, subscriber information, basic plan information, and an overview of benefits (maximums and deductibles).
Recent History
The recent history section, at the top of the benefits summary, displays the most recent treatment history, including date, procedure code, tooth/quadrant, and surface, if applicable. The entire treatment history is available at the bottom of the Summary Breakdown and Full Breakdown.
Coverage Summary
This section breaks down the coverage percentage (coinsurance) or co-pay by category and procedure codes. The procedure codes displayed are the most commonly used codes. The section also shows if the deductible applies to that specific procedure. If the payer does not use procedure codes, coverage and deductible are displayed by service category.
Procedure Benefits
Disclaimers
The disclaimers will vary depending on the insurance company and what third parties, such as Zuub, can access. Detailed information on the coordination of benefits, missing tooth clause, waiting periods, max rollover, etc., is displayed in this section.
Procedure Benefits & Search
This section contains the disclaimers and procedure breakdown by category and ADA code range or service type. By default, it filters by the ADA codes within the portal's settings section. You can toggle it off to see all ADA codes.
The search field allows you to search by procedure code and keyword to find what you are looking for quickly. Click + to expand a category to view coverage, frequency, age restrictions, history, and disclaimers by code and service types.
History
The full treatment history is located at the bottom of the Summary Breakdown and Full Breakdown and provides the patient's full treatment history.
Procedure History
This section displays the patient's full history from when they were insured with this current insurance plan. It displays the service type (ADA procedure code), ADA Code Name, Tooth/Quad, Surface, and Service Date.
Procedure Benefits Search
ADA Code Filtering
By default, the breakdown is filtered by the ADA codes in the portal's settings section. You can always toggle it off if you want to see all ADA codes. These codes are either Zuub's default or the codes your office uses the most, and that is what you'd like to see.
It is important to note that if you want to see all the cleanings, exams, x-rays, and composite fillings, each code must be listed in the settings.
Zuub's default ADA codes: D0120, D0140, D0150, D0180, D0220, D0230, D0272, D0274, D0277, D0210, D0330, D0431, D1510, D9110, D1110, D1120, D1208, D1206, D1351, D2391, D2392, D2393, D2394, D2331, D2330, D2334, D2335, D3220, D3310, D3320, D3330, D7140, D7210, D7220, D7230, D7240, D4210, D4341, D4346, D4910, D4381, D2950, D2740, D2750, D2930, D6210, D5110, D5213, D5750, D6010, D6057, D6065, D8090, D9944
Takeaways
We do not do processing guidelines for any insurance plans at this time.
This resource was updated on 9/3/2024.