Insurance Verification
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      Open Dental - Reference Guide: Insurance Verification

      Keeping track of all the new icons and processes when starting with Zuub can be difficult. Here is a resource that tries to get all the information for you to reference in place.

      Quick Links:

      Glossary
      Insurance Verification Icons
      Common Errors
      Write-back
      Top Payers
      Manual Verifications
      Sync Times
      Friendly Reminders

      Glossary

      AI Solution - Zuub built solutions that pull information directly from Insurance Payer portals. Credentials need to be added and maintained within the Zuub Portal for these solutions to work properly.

      AI solution - Data - Verification pulled via Insurance Payer Portal and presented in a Zuub standardized format.

      AI Solution - PDF - Verification pulled via Insurance Payer Portal and presented in a PDF format.

      Combined - A combination of AI and EDI solutions, where Zuub attempts to pull the information via the AI solution process first, if not available, then Zuub attempts to pull the information via EDI.

      EDI - Insurance Payer controlled channels where information updated and released to third parties such as Zuub. The information Zuub presents is limited to the data that is published in these channels.

      Write-back - Data being written back into the fields within Open Dental.

      PDF Upload - The direct upload of the insurance verification breakdown into Open Dental.

      P - Primary Insurance

      S - Secondary Insurance

      See Verification - This verification was pulled as a PDF breakdown. In order to see the status of the insurance you have to click into the patient ID and look at the actual breakdown.

      Insurance Verification Icons

      Icon Name Description
      Solid Blue P Verification went through successfully. Zuub was able to retrieve information on the patient.
      Solid Blue S Verification went through successfully. Zuub was able to retrieve information on the patient.
      Solid Red P Verification did not go through successfully. Zuub was not able to retrieve information on the patient.
      Solid Red S Verification did not go through successfully. Zuub was not able to retrieve information on the patient.
      Solid Light Blue P Patient has not been verified by Zuub.
      Solid Light Blue S Patient has not been verified by Zuub.
      Filter Function Found in the schedule view, the Filter Function, lets you filter your schedule by verification status, error, payer, and/or provider.
      Loading Wheel Found in the Insurance Verification tab, this appears when you are manually running verifications on a patient and the verification is taking a little longer to pull back a breakdown. When this appears next to the patient's name in the Recent Verifications field, that give you the confirmation to be able to clear the manual form to search another new patient while the verification is completed for the initial patient.

       

      Common Errors

      Error: "Invalid username or password."
      Cause of Error(s): Password or username needs to be updated.

      How to Resolve: Check password by logging onto the Insurance Payer portal. Then navigate to Zuub > Settings > Insurance Verification > General Settings and find the Insurance Payer in the list, select "edit" and update the username and/or password.

      Error: "Account is locked."
      Cause of Error(s): Password was not updated and multiple attempts to log in to pull verification breakdowns resulted in account being locked out.

      How to Resolve: Follow protocol to unlock Insurance Payer accounts. I.e. reset password, call Insurance Payer, etc. Once password is reset, log into the Zuub Portal and update password for all affected accounts.

      Error: "Unable to respond."
      Cause of Error(s): The Insurance Payer’s EDI channel or website was overloaded at the time the verification ran. Manually running the verification again should resolve the issue.

      How to Resolve: On the Schedule View, manually run the verification again by clicking the three dots on the far right of the patient's information and selecting "Verify Now."

      Error: "Patient not found."
      Cause of Error(s): Incorrect first name, last name, date of birth, and/or member ID. Please be mindful of any typos or extraneous information such as middle initials, hyphenated names, and surnames (i.e. Daisy S. Duck, Belle Bookworm-Beast, Mickey Mouse Jr.). Name must match exactly the way it displayed in the Payer portal.

      How to Resolve: Adjust appropriate fields in the Zuub Portal and re-run the patient's verification. Once the verification comes back successfully, make note of the changes you made and update those same fields in your Open Dental for future verifications to go through smoothly.

      Write-back

      There are six fields that are currently eligible for write-back: Patient Eligibility, Patient Benefit Usage, Last Verification Date, Plan Deductible, Plan Maximum, Patient Notes. 

      Payers for Write-back

      A full list of payers that are eligible for write-back can be found in the following resource:
      Payers for Write-back

      Please note due to Change Healthcare being down the payers below are currently not being written back:

      • Aetna
      • Ameritas
      • Anthem
      • BCBS of California
      • BCBS of Maryland
      • BCBS of Nevada
      • Medicaid of Nevada
      • Humana
      • UMR
      • Cigna (only EDI)
      • MetLife (only EDI)
      • United Concordia (only EDI)

      Top Payers

      Connection Type Workflow

      Connection Type Workflow
      AI Solution

      Blue Cross Dental
      Pending confirmation
      Cigna
      Member ID is submitted to retrieve a breakdown.
      If that doesn't work, then First Name, Last Name and DOB are submitted.

      Delta Dental
      Member ID and DOB are submitted to retrieve an insurance breakdown.
      If that doesn't work, then First Name, Last Name and DOB are submitted.
      Note: If either comes back with results in the Payer Portal with a Group ID present and there's more than one result, then Zuub matches on Group ID.

      UMPC
      Member ID is submitted to retrieve a breakdown.
      If that doesn't work, then First Name, Last Name and DOB are submitted.
      EDI First Name, Last Name, DOB, Member ID, Group ID, Insurance Payer and Provider are all submitted to retrieve a breakdown.
      Combined First Name, Last Name, DOB, Member ID, Group ID, Insurance Payer and Provider are all submitted to retrieve a breakdown.

      Top Payer Overview

      Payer

      Connection
      Type

      		 Information Provided Write-back Eligible
      Aetna AI Solution Eligibility, Maximum, Remaining Maximum, Deductible, Remaining Deductible, Coverage Table, Orthodontics, Common Procedures, Frequency, History, Payer ID, Employer Name, Group Number Yes

      Ameritas

      		 EDI Eligibility, Maximum, Remaining Maximum, Deductible, Remaining Deductible, Coverage Table, Orthodontics, Common Procedures, Frequency, History, Missing Tooth Clause, Downgrades, Paid on Date, Waiting Periods, Payer ID, Employer Name, Group Number

      Disclaimer: Other fields vary, so please refer to What Zuub Pulls on Insurance Top Payers.      		 No
      BCBS of Oklahoma EDI Eligibility, Maximum, Remaining Maximum, Deductible, Remaining Deductible, Coverage table, Orthodontics, Common Procedures, Frequency, History, Paid on Date, Payer ID, Employer Name, Group ID No

      Cigna

      		 Combined Eligibility, Maximum, Remaining Maximum, Deductible, Remaining Deductible, Coverage Table, Orthodontics, Common Procedures, Frequency, History, Missing Tooth Clause, Waiting Periods, Payer ID, Employer Name, Group Number

      Yes via AI Solution

      No via EDI

      Delta Dental

      		 EDI Eligibility, Maximum, Remaining Maximum, Deductible, Remaining Deductible, Coverage Table, Orthodontics, Common Procedures, Frequency, Employer Name, Group Number

      Disclaimer: Other fields vary, so please refer to What Zuub Pulls on Insurance Top Payers.      		 No

      Delta Dental

      		 AI Solution Eligibility, Maximum, Remaining Maximum, Deductible, Remaining Deductible, Coverage Table, Orthodontics, Common Procedures, Frequency, Employer Name, Group Number

      Disclaimer: Other fields vary, so please refer to What Zuub Pulls on Insurance Top Payers.      		 No

      Delta Dental

      		 Combined Eligibility, Maximum, Remaining Maximum, Deductible, Remaining Deductible, Coverage Table, Orthodontics, Common Procedures, Frequency, Employer Name, Group Number

      Disclaimer: Other fields vary, so please refer to What Zuub Pulls on Insurance Top Payers.      		 Yes

      Guardian

      		 AI Solution Eligibility, Maximum, Remaining Maximum, Deductible, Remaining Deductible, Coverage Table, Orthodontics, Common Procedures, Frequency, History, Coordination of Benefits, Missing Tooth Clause, Downgrades, Paid on Date, Waiting Periods, Payer ID, Employer Name, Group Number Yes

      Metlife

      		 AI Solution Eligibility, Maximum, Remaining Maximum, Deductible, Remaining Deductible, Coverage Table, Orthodontics, Common Procedures, Frequency, History, Coordination of Benefits, Missing Tooth Clause, Downgrades, Paid on Date, Waiting Periods, Payer ID, Employer Name, Group Number Yes

      Principal

      		 AI Enhanced Eligibility, Maximum, Remaining Maximum, Deductible, Remaining Deductible, Coverage Table, Orthodontics, Common Procedures, Frequency, History, Coordination of Benefits, Missing Tooth Clause, Downgrades, Paid on Date, Waiting Periods, Payer ID, Employer Name, Group Number Yes

      United Concordia

      		 Combined Eligibility, Maximum, Deductible, Coverage Table, Orthodontics, Common Procedures, Frequency, History, Missing Tooth Clause, Paid on Date

      Disclaimer: Downgrades and Coordination of Benefits may differ based on plan, so please refer to What Zuub Pulls on Insurance Top Payers. 

      Yes via AI Solution

      No via EDI

      United Healthcare

      		 AI Enhanced Eligibility, Maximum, Remaining Maximum, Deductible, Remaining Deductible, Coverage Table, Orthodontics, Common Procedures, Frequency, Coordination of Benefits, Downgrades, Paid on Date, Waiting Periods, Payer ID, Employer Name, Group Number

      Yes

      Blue Cross Dental → EDI: Blue Advantage, Arkansas, California, Georgia, Kansas City (MO), Maryland/CareFirst, Massachusetts, Michigan, Oregon/Regence, South Carolina

      Blue Cross Dental → AI Solution: Alabama, DNOA Connect (Illinois, Minnesota, New Mexico, Oklahoma, Texas

      Delta Dental → EDI: Oklahoma and Washington

      Delta Dental → AI Solution (State Specific Portals): Delta Dental, Colorado, Idaho, Illinois, Iowa, Kansas, Massachusetts, Missouri, New Jersey, Northeast (Maine, New Hampshire, and Vermont), Oregon, Virginia, Wisconsin

      Delta Dental → Combined (National Portals):

      • DDIC (Alabama, California, Delaware, Florida, Georgia, Nevada, Louisiana, Maryland, Mississippi, Montana, New York, Pennsylvania, Puerto Rico, Texas, Utah, Washington DC, West Virginia)
      • Delta Dental Toolkit (Arizona, Arkansas, Indiana, Kentucky, Michigan, Minnesota, Nebraska, New Mexico, North Carolina, Ohio, Tennessee and Federal Plans)

      Please Note: For additional information regarding these payers or any other payers, please reference the following document: What Zuub Pulls on Insurance Top Payers

      Manual Verifications

      Schedule View: Navigate to the date the patient is scheduled. Find the patient on the schedule, and scroll to the right hand side of the patient's information to click on the three dots. Click on the three dots and select "Verify Now" from the dropdown.

      Please note: Verifications done this way will be based on the Provider indicated on the appointment and the notes will be written back to the appointment notes. If the appointment Provider is not found, the system will run using the Primary Provider in the patient's file.

      Patient Look-up: Navigate to the "Search for patients" field at the top of the Zuub Portal view and start typing in the patient's name. A list will populate, where the correct patient can be selected. Once selected, the patients breakdown will be presented, where you can select "Verify Benefits" and verify the patient without having to add them to the schedule.
      Please note: Verifications done this way will be based on the Primary Provider unless another individual is selected from the Provider dropdown in the Zuub Portal. Notes will be written back to patient notes.

      Insurance Verification Tab: Navigate to the Insurance Verification tab in the Insurance Verification module. This will display a manual form that can be used to verify patients. This tab should only be used for patients that are not of record, as nothing is written back or uploaded into your Open Dental, even if there are successful verifications from this tab.

      Sync Information

      Field Type Sync Type Cycles Paramaters
      Appointment Details

      Open Dental > Zuub

      		 3 to 5 minutes N/A
      Patient Details Open Dental > Zuub 3 to 5 minutes N/A
      Insurance Details Open Dental > Zuub 30 minutes N/A
      PDF Zuub > Open Dental 30 minutes Uploaded once every 24 hours*
      Write-back Zuub > Open Dental 30 minutes Uploaded once a day**

      *If you are manually re-running a patient and a PDF was already uploaded in the last 24 hours, you will need to manually download the breakdown from Zuub and upload it into Open Dental.

      **If you are manually re-running a patient and a note was written back the day before, you will see another note write back into Open Dental.

      Friendly Reminders

      • PDF uploads for successful verifications only occur once within a 24 hour time frame.
      • Always check the group number when looking into a patient's breakdown. Zuub currently only pulls back data on a patient based on the payer.
      • Automation is set based on each individual location's operating hours. If there are ever any changes to the operating days please navigate to your Settings.
      • Incorrect credentials should always be addressed right away. Please navigate to your Settings to update. 

      This resource was updated 9/11/2024.