How do I add and edit a patient's insurance details in Canada?
💡 Top tip: Adding a patient's insurance details MUST be done before sending insurance claims through Dentally.
To add insurance details to a patient's record, you will need to add or amend a policy. You can enter and manage insurance policy information for the patient, including their usage limits and any associated dependents.
To add an insurance policy to a patient's record:
In Dentally, go to the 'Insurance' tab in the patient's record.
Click on the button ‘+ Add policy’.
A table will appear listing available plans. Select your chosen insurance plan by typing the carrier name, group/ plan number, or plan identifier in the search box, then selecting your desired plan from the results. Alternatively, you can click '+ Add plan' to add a new insurance plan if required before continuing.
Identify your chosen plan and click it in the list - then click 'Select plan' at the bottom of the list.
The 'Plan Details' section will be auto-populated with the details you have already set up for the plan you selected. If you wish to make changes to the plan as a whole, you can click 'Edit plan' in the top right corner.
📝 Please note: If you choose to edit the plan, the changes you make will apply to all patient policies where that plan is assigned. Please review the affected policies and patients carefully before proceeding.
You can also go back by clicking 'Select a different plan' at the top if you have made a mistake.
Under the 'Policy Details' section, complete the fields as required:
'Policy ID': Enter the unique identifier for the patient’s insurance policy.
'Card sequence or version number': This is typically not required for most insurance carriers. It is only relevant for RAMQ (Quebec’s public dental insurance plan). For all other plans, you can leave this field as 0.
'Claim submission method': Select whether the claim will be submitted digitally (through CDAnet) or manually.
'Assignment of benefits': Select 'Yes' if the insurance carrier will pay your practice directly, or 'No' if the payment will be made to the patient.
'Coverage start': Choose the date the coverage begins.
'Limits reset': Select how often the coverage resets - 'Annually' or 'Every two years'.
'Next reset': This will be automatically calculated based on the start date and reset frequency.
You’ll also see a section showing the patient’s coverage and limits. Dentally automatically sets the coverage amounts for Basic, Major and Ortho based on the maximum limits defined at the plan level. These are editable for this specific policy, so ensure you review them to ensure they match the patient’s actual policy usage.
You can add comments to the policy to include any notes relevant to this patient’s coverage, or you can leave the comment section blank.
🚨 Important to remember: Dentally will automatically track usage against these limits when claims are submitted, so accuracy here is essential for keeping totals up-to-date.
You can also add dependents underneath by clicking the '+ Add dependent' button in the bottom right.
If the patient has linked family members in Dentally, those will be shown automatically. If there are no linked family members, you can search for an existing patient or add a new one .
Select the relationship to the policy holder (eg. spouse, child, common law spouse).
Enter the dependent code, which is generally assigned by the insurance provider.
Click 'Add to policy' to attach them to this policy.
If a dependent is removed from the policy, it will no longer appear under their insurance policy details, but any existing claims associated with the policy will remain valid as long as the policy still exists in Dentally.
When you have finished setting up the policy and adding any dependents, click the blue 'Save' button in the top right.
📝 Please note: You can add multiple policies to a patient's record. Primary and secondary policies will be selected automatically in accordance with the claiming rules. You can override this order by using the 'Reorder' button on the patient's 'Insurance' screen.
How do I run an eligibility check on a patient's insurance policy?
In Dentally, go to the 'Insurance' tab in the patient's record.
Click on the blue 'Run eligibility check' button in the top right.
If your policy is not supported, you will not be able to run the eligibility check. If your policy is supported, it will be checked directly with CDAnet.
