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.

🔄 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:
1. Open a patient in Open Dental.
2. Click the Foji Button to initiate verification.
3. Foji searches the appropriate insurance portal using patient and plan info from Open Dental.

✅ Insurance Verification Outcomes

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

📝 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.

📅 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.

🧾 Full Insurance Benefits Updates 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)

📄 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.

🔐 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.

🚀 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.