How To: Set Up Insurance Verification

How To: Set Up Insurance Verification

Setting up Adit’s Revenue Cycle Management (RCM) system is the first step toward automating your front-office insurance workflows. Powered by high-speed EDI infrastructure and a manual fallback option (available with the Advanced package), this setup ensures comprehensive verification coverage across Dental, Optometry, Orthodontics, and Chiropractic specialties.

Getting Started

When you first access the RCM module within the Adit platform, you may see a welcome screen that introduces the feature and prompts you to schedule a demo.

If this page is displayed, your account has not yet been upgraded to include Insurance Verification. In this case, please connect with a member of the Adit team to proceed.

Selecting Get Started will guide you through the setup steps outlined below.

Schedule Consultation

Clicking Schedule Consultation allows you to book a session with the Adit team. During this consultation, our team will walk you through the configuration process and help validate the required information for your practice.

Practice Information

Once your account has been successfully upgraded, you will be prompted to enter basic practice details. This information is used exclusively by the Adit verification team to accurately verify patient insurance coverage.

Complete all required fields and click Next to continue.

Throughout the setup process, you may:

  • Select Back to return to the previous step
  • Select Cancel to exit the setup flow at any time

Verification Settings

Trigger Settings

Configure how far in advance of an appointment insurance verification should be initiated. You can select either:

  • 3 days prior to the appointment
  • 5 days prior to the appointment

EHR / PMS Settings

Choose how verification results are written back to the patient’s record in your EHR/PMS:

  • Attach a PDF of the verification results
  • Add a note to the patient’s chart
  • Or apply both options

If PDF attachment is enabled:

  • All available folders from your EHR will be displayed
  • Select the folder where eligibility PDFs should be stored

If notes are enabled, you may also define a preferred template or format for consistency.

Select Treatment (Tx) Codes

Basic and Advanced verification packages share a similar structure, with important functional differences.

Each treatment code includes 1 to 4 verification questions, which may include:

  • Whether the treatment is covered and at what percentage
  • Age limitations for coverage
  • Frequency limitations
  • Patient eligibility and next eligible date

You can specify exactly which treatment codes should be included in:

  • Basic Eligibility Verification
  • Advanced Eligibility Verification

The treatment codes you select will be checked every time a patient undergoes that type of verification.

Basic Package

  • Select up to 20 treatment codes
  • Verification responses are sourced entirely from EDI
  • No manual intervention is performed

One-Off Upgrade (Basic → Advanced)

Clients on the Basic package can upgrade individual appointments to Advanced verification using the One-Off Upgrade option.

Upgrade Options:

  • Standard
    • Up to 20 treatment codes
  • Extensive
    • Ability to select up to 40 treatment codes

If no additional codes are selected, only the treatment codes defined in Preferences will be verified.

Advanced Package

Standard

  • Select up to 20 treatment codes
  • Initial verification via EDI
  • Followed by manual verification

Extensive

  • Select up to 40 treatment codes
  • Initial verification via EDI
  • Followed by manual verification

Insurance Mapping

The final step in the setup process is Insurance Mapping.

You will see a list of insurance names as they appear in your EHR/PMS. Each must be mapped to Adit’s master insurance list using the corresponding dropdown.

This standardization ensures consistent insurance handling across the RCM module and the broader Adit platform.

Example:

Your EHR may list an insurance as BCBSTX, while Adit’s master list uses Blue Cross Blue Shield of Texas. Select the appropriate standardized option from the dropdown.

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