How To: Set Up Insurance Verification
Setting up Adit’s Revenue Cycle Management (RCM) system is the first step toward streamlining and automating your front-office insurance workflows. Leveraging a high-speed EDI infrastructure, along with an optional manual verification fallback (available in Advanced packages), this setup ensures accurate and comprehensive eligibility verification across Dental, Optometry, and Orthodontic practices.
Getting Started
Navigate to the RCM Module
When you first access the RCM module within the Adit platform, you may see a welcome screen introducing the feature and prompting you to schedule a demo.
If this screen appears, it indicates that your account has not yet been upgraded to include the Insurance Verification feature. In this case, please connect with a member of the Adit team to enable access.
Clicking Get Started will guide you through the setup steps outlined below.
Practice Information
Once your account has been successfully upgraded, you will be prompted to complete the Practice Information section. This information is used to process insurance verification requests accurately.
Enter all required details under Enter in the information required for verification and ensure all mandatory fields (marked with *) are completed.
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Please Note: Incorrect or missing information may cause verification requests to fail or return inaccurate eligibility results. |
After completing the form, click Next to proceed. During the setup process, you can:
- Click Back to return to the previous step
- Click Cancel to exit the setup at any time
NPI Settings
In the NPI Settings section, select how you want to configure provider NPIs for verification:
- Choose One NPI if you want to use a single default NPI for all verifications
- Choose Multiple NPI to assign different NPIs based on the provider associated with each patient
Under Set up each Provider’s NPI, click Add Provider to enter provider details. In the Provider Information section, enter the following details exactly as configured in your EHR:
- Provider name
- NPI
- Tax ID
Ensure that all provider details are accurate and match your EHR records.
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Please Note: Incorrect or missing information may cause verification requests to fail or return inaccurate eligibility results. |
Additionally, configure each provider’s network participation and fee schedule to ensure that benefits retrieved through automation or EDI reflect the correct in-network or out-of-network status.
After completing the setup, click Next to proceed or Back to return to the previous step.
Verification Settings
Trigger Settings
Under Trigger Selection, choose how many days before the appointment Adit should verify patient benefits. Select your preferred option (e.g., 3 Days Before Appointment or 5 Days Before Appointment).
Verification Settings
Under Frequency Selection, choose how often patients should be verified between appointments. The default setting is 6 Months, but this can be adjusted based on your practice needs.
EHR / PMS Settings
Eligibility Verification PDF Settings
- Choose Yes or No for attaching the Eligibility Verification PDF to the patient’s file
- If Yes is selected, choose the folder from the dropdown where the PDF should be stored (File Name Format: Verified Date - Patient Name)
Patient Note Settings
- Choose Yes or No to add a note to the patient’s file after verification
PPO Template
Provide the preferred format for notes under PPO Template. You can use available fields such as:
- Insurance Carrier
- Verification Date
- Plan Maximum / Plan Remaining
- Ortho Maximum / Ortho Remaining
- Deductible Met (Ind)
HMO & Other Template
Define the format for notes under HMO & Other Template to ensure consistency in documentation.
Select 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, if applicable
Within the settings for Adit’s Insurance Verification feature, you can specify exactly which treatment codes should be included in either an Advanced Eligibility Verification or a Basic Eligibility Verification. The treatment codes you select will be checked every time a patient undergoes that type of verification.
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Basic Package
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Advanced Package Standard: up to 20 codes Initial verification via EDI, followed by manual verification. Extensive: up to 40 codes Initial verification via EDI, followed by manual verification. |
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 include:
- Standard: Up to 20 codes
- Extensive: Ability to select additional codes up to 40 codes
If no additional codes are selected, only the treatment codes defined in Preferences will be verified.
Notification Settings
This setting determines how your practice is notified when a verification request fails.
Enabling email alerts ensures that your team is promptly informed of any failed verifications, allowing timely follow-up and preventing disruptions in patient workflows.
If email notifications are not enabled, failed verifications may go unnoticed. This can result in patients arriving with unverified insurance, leading to potential billing issues and front desk delays.
Automation Credentials
In the Automation Credentials section, Adit requires access to your insurance portal login credentials to automatically retrieve eligibility information on your behalf.
Enter the required credentials for each insurance listed to enable automated verification.
- Click Connect to securely add or authenticate credentials for a specific insurance
- Once connected, the Status will display as Authenticated
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Please Note: The credentials provided here are used only for system automation and should not be used for manual login purposes. |
Providing accurate and up-to-date credentials ensures seamless and uninterrupted eligibility verification.
Portal Credentials
In the Portal Credentials section, provide login credentials for insurances that do not support full automation.
These credentials enable Adit to perform manual verification or detailed eligibility audits when automated (EDI) verification is not available.
- Enter the required portal Username and Password for each applicable insurance
- Ensure credentials are accurate and kept up to date for successful verification
Providing valid portal credentials helps improve verification coverage and ensures more comprehensive benefit details when automation is not supported.
Insurance Mapping
The final step in the setup process is Insurance Mapping. In this section, you will see a list of insurance names exactly as they appear in your EHR/PMS. Each insurance must be mapped to Adit’s standardized master insurance list using the available dropdown.
This mapping ensures consistent insurance identification and accurate processing across the RCM module.
Example: An insurance listed in your EHR as BCBSTX may correspond to Blue Cross Blue Shield of Texas in Adit’s master list. Select the appropriate standardized option from the dropdown to complete the mapping.
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Note: Accurate mapping is critical to ensure successful verification and correct eligibility results. |
After completing all mappings, click Next to proceed.
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