Each night, the Synchronizer syncs patients' insurance information from your health record system and automatically verifies insurance coverage for appointments scheduled in the next 7 days. This timeframe is customizable, giving you the flexibility to match your verification process.
Verification also can be accomplished by using our Dental Insurance form for automatic verifications before each appointment, or information can be verified manually by entering a patient's insurance details in the verification modal.
For each active verification, NexHealth generates an Eligibility PDF with a summary of benefits including all the information provided by the payer. Information typically includes deductibles, procedure coverages, in and out-of-network benefits, and more.
To get started with Verification, follow the steps below:
Fully integrated insurance verification (Dentrix, Dentrix Enterprise, Eaglesoft, and OpenDental)
Set the destination folder for your Eligibility PDF Sync
Optional: Adjust the verification window (the default is 7 days before appointments) Verification begins automatically when an appointment enters the verification window
Optional: Set up smart form rules to send the Dental Insurance form automatically or add the Dental Insurance form to packets and/or templates
Non-insurance integrated verification with NexHealth integrated forms (other systems that integrate with NexHealth)
Optional: Adjust the verification window (the default is 7 days before appointments).
Optional: Set up smart form rules to send the Dental Insurance form automatically or add the Dental Insurance form to packets and/or templates
Verification will happen automatically based on information on the Dental Insurance verification form when the appointment enters the verification window, or immediately upon receipt if it is already in the window
Non-insurance integrated verification without forms (manual on-demand verification)
Set the destination folder for the Eligibility PDF
*Note: This feature is only available for systems with NexHealth's integrated forms.
1. Navigate to the gear icon and choose Settings.
2. Select Eligibility PDF sync.
3. Select the Eligibility PDF destination folder from the drop-down menu (if you do not see yours listed, ask your Onboarding Manager, or contact Support).
4. Adjust your Sync preferences (if desired). Automatic will sync the Eligibility PDF to the patient chart in your health record system. Manual will allow you to review the PDF before downloading it and uploading it into your health record system.
Adjust the Verification window
1. Select Verification window from the left side menu.
By default, verification is set to run 7 days before a patient's appointment.
2. Click Edit to adjust the window.
3. Click Save.
4. Adjust Dynamic windowing if desired. Dynamic windowing adjusts your standard eligibility window for appointments early in the month to ensure you have the most up-to-date insurance information.
Add a Global NPI and Tax ID
Adding a Global NPI and Tax ID ensures that provider data pre-fills for each verification, reducing manual entry for On-Demand checks, and ensuring that verification happens automatically from the Dental Insurance form. (Note: providers can still modify the NPI and Tax ID on the On-Demand form if needed.)
1. Select NPI and Tax ID from the left side menu.
2. Click on Use single global NPI and Tax ID.
3. Enter the Provider Name, NPI and Tax ID you want to use for verification.
4. Click Save.
Verify insurance manually
Select the patient from the Home page appointment list, or use the search bar to locate the patient chart in NexHealth.
Click on the patient's name to open the profile.
Open the Insurance tray by clicking the down arrow.
Choose Verify eligibility on demand.
5. Complete the required information for the patient and click Verify. The patient's Insurance eligibility will be returned within seconds!
When patient information for verification is entered manually, if an error is returned with instructions to resolve the issue, the patient's insurance information will be prefilled after making the corrections so you do not have to enter it again.
NexHealth will store that patient's insurance information so the next time the patient has an appointment, the information will not have to be re-entered (as long as their insurance info has not changed), and their insurance will be automatically verified when the appointment enters the verification window.
You can manually run a verification of a patient's primary or secondary insurance anytime.
View patients' coverage
Patients scheduled for each day appear on your NexHealth Home page. The Insurance column highlights patients’ verification status.
The Insurance status is displayed as one of four icons:
Grey clock = insurance verification is pending (the appointment is not yet in the window, or has not yet been verified)
Green checkmark = insurance verification has been completed and the coverage is Active, or the patient has been marked as Self pay.
Orange caution triangle = insurance verification has been attempted, but there is an issue. This may say Investigate, or Unknown. Opening the patient's chart will usually provide additional information and steps to resolve the issue.
Grey circle with a dash = insurance is Inactive, Unverified, or verification Failed.
For specific coverage information, click the patient’s name to open their profile.
Click the down arrow in the Insurance Eligibility area to reveal the status of the patient’s verification and access the Eligibility PDF.
Mark patients as Self pay
Patients without insurance can be marked as Self pay to ensure their insurance status on the Home page does not cause unnecessary work or count against your monthly verification limit.
Open the patient’s profile.
Expand the Insurance Eligibility drawer by clicking on the down arrow to the right.
Select Change eligibility status.
4. Choose Self pay.
5. Click Save.
The patient's status will appear as Self pay:
