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:
- 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.
✅ Insurance Verification Outcomes
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.