Carriers and payer mapping

Before Teamio can ask a carrier about a patient, it has to know which payer that carrier is on the electronic network. Most of the time it works this out on its own. The Payer mapping tab is where you fix the ones it can’t — and where you tell it to stop trying on carriers that will never answer usefully.

Where: Benefits & eligibility → Precheck settings → Payer mapping.

Prerequisites & permissions

Admin / Super Admin only, like the rest of Precheck settings.

Everything on this tab is free. Looking up and mapping payers sends no eligibility checks and costs nothing.

How a carrier gets resolved

Carriers resolve to a Stedi payer automatically when Open Dental has an Electronic ID or a global default exists. Anything left Unmapped can’t be verified until you add a payer ID below.

In order:

1. The carrier’s Electronic ID in Open Dental. This handles the overwhelming majority of a well-maintained book — often well over 90% of patients, with no mapping work at all.
2. A mapping you’ve saved here, which overrides everything for that carrier.
3. A small global default list Teamio maintains for a handful of large national carriers matched by exact name.

If none of those produce an answer, the carrier is Unmapped.

Tip

If this tab shows almost nothing to do, that’s a good sign — it means your Open Dental carrier records already carry correct Electronic IDs.

The list

Each row is one carrier from your Open Dental, with:

• A status chip — Unmapped (red) or a green Mapped (…) telling you how it resolved:
  • Mapped (OD ElectID) — from the Electronic ID in Open Dental
  • Mapped (manual) — from a payer ID you saved here
  • Mapped (default) — from Teamio’s global list
• The resolved Payer {id}, once mapped
• A Payer ID box and Save button
• An Exclude from electronic verification toggle

Use Search carriers… to find one, or tick Unmapped only to work through the backlog. The count beside it is how many are unmapped.

Mapping a carrier

1. Find the carrier — Unmapped only is the fastest route.
2. Type the payer ID into the Payer ID box.
3. Select Save. The chip flips to Mapped (manual).

Payer IDs are text, not numbers — keep any leading zeros exactly as given.

Caution

Don’t guess a payer ID by picking a similar-sounding national carrier. Plans like Cigna Dental Network Access, Aetna Dental Access Plan and Careington are discount or network-access products, not insurance — they don’t support electronic eligibility at all. Pointing one at the real Cigna or Aetna sends checks for members that carrier has never heard of: guaranteed failures that are still billed. When you don’t know the ID, just leave it unmapped — an unmapped carrier is never sent to the network and never billed. You don’t need to exclude it as well.

The better long-term fix for most carriers is to put the correct Electronic ID on the carrier record in Open Dental. That resolves it here automatically and fixes it everywhere else in your practice too.

Excluding a carrier

Some carriers technically answer an eligibility request but tell you nothing — no annual maximum, no deductible, no ortho allowance. The check succeeds, bills, and leaves you no better off. Capitation and network-access products are the usual culprits.

Unmapped and excluded are not the same thing

• Unmapped carriers are already skipped for free. Teamio has no payer to send the request to, so nothing goes out and nothing is billed — whether or not you also exclude them.
• Exclude is for carriers that would be checked: mapped ones that answer, bill you, and tell you nothing useful.

Excluding an unmapped carrier doesn’t save you anything. It does change two things: those patients show Excluded on the dashboard instead of an unmapped warning, and they stop taking up a place in the nightly run. The carrier still counts as unmapped on this tab.

Turn on Exclude from electronic verification for those. From then on:

• They’re never checked automatically.
• The dashboard shows an Excluded tag instead of a Verify button.
• Trying to verify one anyway returns “No check was run (no charge)”, naming the carrier and pointing you back here.
• The dashboard shows a grey banner listing them: “{names} will not be checked. Verify by phone, or change this in Precheck settings.”

This saves as soon as you toggle it — you don’t need to save the Automation tab as well.

Note

Start with an empty exclusion list. There’s no way to know in advance which carriers answer with nothing useful for your patient mix; add them as your team hits them.

”Unrecognized carrier ID” on the dashboard

This amber chip means a carrier’s Electronic ID in Open Dental isn’t one any payer on the network answers to — often a placeholder or catch-all ID that was never a real payer ID.

• These checks are free. They can’t be routed, so they never reach a payer and are never billed.
• But those patients can’t be verified at all until the ID is corrected.

Fix it on the carrier record in Open Dental. One correction usually clears a large batch of patients at once, since a catch-all ID is typically shared across hundreds of them.

Carriers that don’t support electronic eligibility

A few payers simply don’t offer electronic eligibility. For those, the drawer shows Can’t be verified electronically:

This plan has to be verified by phone. Checking again won’t help — the payer doesn’t offer electronic eligibility at all.

There’s deliberately no Verify button on that state, and nothing is billed. Phone those in.

Troubleshooting

A carrier appears twice

Open Dental can hold more than one carrier record with the same name — different plans, different addresses. Map each one, or fix the duplicates in Open Dental.

I mapped a carrier but patients still won’t verify

Check the dashboard’s Action required chips for that patient. A correct payer mapping doesn’t help if the member ID is missing or a placeholder.

The list is empty

Teamio reads carriers from your Open Dental. “No carriers found for this practice” means the connection isn’t returning them — contact Teamio.

Related

• Precheck settings
• What each status and message means
• The Benefits & eligibility dashboard