This release introduces a revamped insurance verification (IV) breakdown. Users can easily access the most critical information and search for specific codes in concise and normalized view.
Insurance Verification Schedule
Remaining Benefits, Deductible
The individual Remaining Benefits and Deductible on the Schedule follow the same logic as the Network dropdown on the IV breakdown; see below. Therefore, the values match on the Schedule and breakdown.
Insurance Verification Breakdown
Highlights
- The header bar is sticky and will remain at the top of the page as you scroll. The header displays the patient’s status, individual remaining benefits and deductible, insurance payer, and latest verification date.
- Patient information is the action bar where you can edit insurance information, select the network, save the verification to PDF, and manually initiate an insurance verification.
- Summary Breakdown provides an overview of the patient’s insurance plan and benefits, focusing on the most common data points and recent treatment history. The Full Breakdown includes more detailed plan information.
- Coverage Summary provides the coverage information for typical procedure codes for an appointment.
- Procedure Benefits condenses coverage, frequency, age restrictions, and history by code and service categories with powerful search functionality.
- The entire treatment history is at the bottom of the page.
Article: Insurance Verification Breakdown
Patient Action Bar
Network Dropdown
The value selected by default is based on the account settings (Settings > Insurance Verification > Insurance Payer Mapping > Network Status) for mapped payers. The dropdown only displays values relevant to the patient according to the payer. Network data is unavailable in the dropdown until a successful IV runs.
Based on account settings, the following payer-network-specific logic applies:
- Cigna - for DPPO and DPPO Advantage:
- When settings Network Status = DPPO, show DPPO; if not available, show DPPO Advantage
- When settings Network Status = DPPO Advantage, show DPPO Advantage; if not available, show DPPO
- When settings Network Status = DPPO and DPPO Advantage, show DPPO Advantage; if not available, show DPPO
- Delta Dental - for PPO and Premier:
- When settings Network Status = PPO, show PPO; if not available, show Premier
- When settings Network Status = Premier, show Premier; if not available, show PPO
- When settings Network Status = Premier and PPO, show Premier; if not available, show PPO
- When settings Network Status = “I don’t know”:
- Show any of the available networks
- Generic: show the in-network before out-of-network
- Cigna: show DPPO before DPPO Advantage before out-of-network
- Delta: show PPO before Premier before out-of-network
- Show any of the available networks
- When settings Network Status = out-of-network, show the out-of-network values; if not available from the payer, the above logic applies.
The Remaining Benefits and Deductible on the Schedule follow the same logic. Therefore, the values match on the Schedule and breakdown.
Benefits Summary
Disclaimers: Waiting Period, Missing Tooth Clause, Downgrades, Coordination of Benefits
Waiting Period, Missing Tooth Clause, and Downgrades will display “Applies” or “Does Not Apply” if Zuub can access and normalize disclaimers from the payer. Coordination of Benefits will display a value if Zuub can access and normalize disclaimers from the payer. Otherwise, when data exists click “Check Disclaimers” to go to the Disclaimers section. When disclaimers are not available or applicable, these fields will be blank.
Assignment & Office Effective Date
If the plan type is not HMO or Medicaid, this field displays N/A.
History
If a procedure was performed on multiple surfaces on one tooth, the procedure may be displayed in two rows, with the surface value being different and the other values being the same. If available, Recent History is near the top of the Summary Breakdown and complete History is at the bottom of both breakdowns.
Coverage Summary
Non-ADA Code Service Types
When the payer does not use ADA codes, Procedure will be blank. In this section, Service Types not using ADA codes are mapped to the standard categories. When multiple service types with different coverage are mapped to the category, it is possible to display a range for Coverage % (##%—##%).
Maximums & Deductibles
The service type will display ADA codes if they are available.
Procedure Benefits Search
Frequency, Age Restrictions, Deductible Applies, Disclaimers and History display available data.
Filter for My ADA Codes
Toggled ON by default to display ADA codes in the account settings (Settings > Insurance Verification > General Settings > Verification Codes and PDF/View Quick Filters). All service types are available when the payer does not provide ADA codes.
Non-ADA Code Service Types
Service types not using ADA codes are mapped to the standard categories. Some payers use ADA codes for some service types. The search field allows ADA codes and keywords in a comma-separated list. Keywords can be partial names of procedures. Keyword searches Procedure and ADA/Procedure Category (the first two columns per code/category).
Other Services
Service types in this category are unmapped to a standard category.
Waiting Periods
When data is available and applicable to a patient’s plan.