View source for Foji Insurance Verification AI Agent – Open Dental Integration


== Overview ==
Foji’s AI-powered Insurance Verification Agent automates the time-consuming task of verifying patient insurance coverage—fully integrated with '''Open Dental'''. By reading and writing directly to appointment fields, patient records, and the Imaging module, Foji gives dental teams real-time visibility into insurance status without jumping between portals or spreadsheets.
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== 🔄 '''How to Run the AI in Open Dental''' ==

=== 1. '''Automated Trigger (Default Setting)''' ===

* '''What it does''': Foji automatically checks upcoming appointments in Open Dental.
* '''Default timing''': Kicks off verification '''8 days before''' each scheduled appointment.
* '''How it works''': Uses the appointment date and patient insurance data in Open Dental to search payer portals and verify active coverage.

=== 2. '''Manual Trigger – The “Foji” Button''' ===

* '''Where it's found''': Inside the '''Open Dental toolbar'''.
* '''How it works''':
*# Open a patient in Open Dental.
*# Click the '''Foji Button''' to initiate verification.
*# Foji searches the appropriate insurance portal using patient and plan info from Open Dental.

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== ✅ '''Insurance Verification Outcomes''' ==
[[File:Appointment-After.png|thumb|Updated Appointment Field by Foji AI Agent]]
Foji’s AI will update Open Dental with one of three possible statuses:

=== 1. '''Verified – Active''' ===

* Status written back to the '''Appointment as field'''.
* Date and time of verification included.
* Benefits are ready to be updated if needed.

=== 2. '''Terminated''' ===

* Status clearly labeled on the '''Appointment'''.
* Front desk can follow up with the patient before the appointment.

=== 3. '''Not Verified''' ===
Common reasons include:

* Name mismatch
* Incorrect group number
* Wrong ZIP code
* Portal doesn’t recognize patient info

<blockquote>📝 Foji logs the '''reason''' for failure in the '''Appointment Notes''' and allows users to correct the information, then manually re-run using the '''Foji Button'''.</blockquote>
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== 📅 '''Appointment-Level Status View in Open Dental''' ==
To help front-desk staff stay organized, Foji writes verification results directly to the '''Appointment Module''' in Open Dental using:

* '''Appointment Note''' – Includes insurance status and explanation (if not verified).
* '''Optional Custom Fields''' – Status field can display '''“Verified,” “Terminated,”''' or '''“Not Verified”''' for quick glance reviews.

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== 🧾 '''Full Insurance Benefits Updates in Open Dental''' ==
[[File:InsurancePlan-After.png|thumb|AI Agent Updating the Insurance Plan's Benefits in Open Dental]]
Foji can also fetch and update full insurance benefits into Open Dental.

=== How It Works: ===

# '''Check Active Status''': Must be verified as active.
# '''Check Last Verified Date''': Default re-verification is every 90 days. You can adjust to:
#* 30 days
#* 60 days
#* Or any custom interval
# '''Update Benefits''':
#* Foji populates benefits into the '''Insurance Plan''' section of Open Dental.
#* Categories and codes are written directly to benefit rows.

=== Customizable Settings: ===

* Set '''manual override rules''':
** Leave existing fields unchanged
** Always override with new data
** Skip certain benefit types (e.g., ortho, implants, fluoride)

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== 📄 '''Optional: Benefit Summary PDF in Imaging Module''' ==
Foji can auto-generate a clean, patient-friendly PDF summarizing benefit details:

* CDT code groups (Preventive, Restorative, Perio, etc.)
* Specific coverage percentages
* Frequencies, waiting periods, and more

📂 PDF is uploaded directly to the '''Imaging Module''' under the patient’s file for quick access by your front desk or treatment coordinator.
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== 🔐 Data Integrity & Audit ==

* All verification timestamps are logged in '''the patient's insurance view'''.
* Benefit updates include date stamps in '''Insurance Plan'''.
* PDF summaries serve as an easy audit trail and front-office reference.

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== 🚀 Getting Started with Foji in Open Dental ==

* Ensure your practice has portal access for your accepted insurance payers.
* Work with the Foji team to configure:
** Trigger settings (auto/manual)
** Benefit update frequency
** Code-level overrides
* Begin seeing updates flow into your Open Dental appointments, insurance plans, and imaging module—no more insurance chaos.

[[Category:ForgeAI]]