Eligibility checked too late
A patient arrives before anyone has confirmed the plan or remaining benefits.
Where verification breaks
Coverage problems surface at the worst time
Coverage buried in a note
Plan details live in a document or a sticky note instead of the patient record.
Claim surprises
A missing detail turns into a rejected claim and another call to the patient.
What SmileCare handles
The plan, the check and the claim in one place
Insurance plan per patient
Carrier, member ID, group, subscriber, plan type, maximum, deductible and plan-year reset.
Eligibility checks
Run eligibility through the configured gateway and save a dated snapshot on the chart.
Pre-visit checks
Batch upcoming appointments so coverage is reviewed before the visit.
Predeterminations and claims
Prepare predeterminations and claim files with CDT lines through the clearinghouse adapter.
A/R and follow-up
See outstanding claims and the next action from the same patient account.
Audit trail
Coverage changes and claim activity stay reviewable in the audit log.
How it works
Before the visit, not after the claim
Store the plan
Capture the patient insurance details once and keep them on the record.
Check eligibility
Run a real-time or pre-visit check and save the snapshot.
Follow through
Use the coverage and claim status when preparing the estimate and the claim.
What to verify before switching
- The eligibility gateway is configurable; live payer access depends on your gateway agreement.
- Claim submission requires a signed clearinghouse agreement; the adapter can prepare test files first.
- SmileCare does not claim AI eligibility or AI claims processing today.
FAQ
Common questions
Does SmileCare verify insurance eligibility?
Yes, through a configured eligibility gateway. Eligibility checks can be saved as dated snapshots on the patient chart. A live payer connection depends on the gateway agreement.
Can we check eligibility for upcoming appointments in batch?
Yes. Pre-visit eligibility checks can be run for upcoming appointments so the front desk sees coverage before the visit.
Where is the insurance plan stored?
The plan is stored on the patient record, including carrier, member ID, group number, subscriber, plan type, maximum, deductible and plan-year reset date.
Does SmileCare submit predeterminations and claims?
Predeterminations and claims go through the configured clearinghouse adapter. Live payer submission requires a signed clearinghouse agreement.
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Move records, appointments and billing with less downtime.
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