Purpose
Process an insurance verification (OPS) request from the internal BrandaCare dashboard to submission to the carrier.
Time: 5-15 min per verification
Pre-checks
| Check | How to verify |
|---|---|
| Insurance Verification Ticket open | Dashboard → Tickets → Status: Open |
| Patient data complete | Subscriber ID, DOB, Insurance from dropdown |
| Provider info correct | NPI, Tax ID of client |
| Carrier portal access | Availity, DentalHub, or direct portal |
Steps
1Identify the correct plan
See SOP-OP-004 (Insurance Plan Identification & Validation Hierarchy) to properly identify carrier + group.
2Access the right portal
By carrier:
- Multi-carrier → Availity
- Cigna → Cigna portal
- UHC → DentalHub or UHC portal
- Delta Dental → regional Delta portal
3Fill patient data
Subscriber ID + Date of Birth. If dependent, confirm relationship.
4Verify structural benefits
See TRN-INS-002 — Coverage Structure for full checklist.
5Frequency Check (the differentiator)
For each relevant procedure, note frequency + last service date + Plan Variants.
6Complete BC Breakdown
Fill coverage in BC Breakdown format. For new patients → NP BC Breakdown attachment.
7Submit + close ticket
Submit on dashboard → status Closed/Verified → notify office if action required.
Troubleshooting
| Issue | Solution |
|---|---|
| Carrier doesn't respond to 276 via Stedi | See TRN-INS-G02 — find carrier → use manual portal |
| Invalid Subscriber ID | Request updated card from patient |
| Plan not identified | See SOP-OP-004 — Validation Hierarchy |
| Missing clinical narrative | Escalate to clinical team |
Note: This SOP is a skeleton based on the Google Doc. For current operational details (screenshots, click-by-click), work on it in the Operations team Cowork chat, then pass it to me to update.