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FOJI Benefits Overview

Full Benefits Reference

What FOJI Does with Benefits

FOJI connects directly to payer portals and pulls full benefit data including coverage, deductibles, frequencies, age limits, and waiting periods when available. It translates that data into Open Dental's format and updates plan benefits with key notes so treatment plans calculate correctly. FOJI follows Open Dental's coverage category hierarchy exactly.

Where FOJI Puts Codes in Open Dental

FOJI maps codes into your existing Open Dental coverage categories in the following order:

  1. Diagnostic
  2. Preventive
  3. Restorative
  4. Endodontics
  5. Periodontics
  6. Oral Surgery
  7. Crowns
  8. Prosthodontics
  9. Orthodontics
  10. Adjunctive

If a specific code needs a unique percentage, deductible, or age limit, FOJI adds it under Other Benefits so treatment plans stay accurate. Carrier-specific examples: Cigna — FOJI searches specific codes individually using your custom code list. MetLife — FOJI pulls the full benefit table and maps everything automatically.

What FOJI Writes into Open Dental

Benefit Configuration

  • Category coverage percentages (Diagnostic, Preventive, Restorative, etc.)
  • Deductibles (individual, family, and by category)
  • Frequencies and limitations (e.g., 2 per 12 months)
  • Age limits (fluoride, sealants, ortho, fillings)
  • Orthodontic details (percentages, lifetime max, age limit)
  • Calendar year vs. service year settings

Patient & Plan Notes

  • Remaining annual max and deductible (optional write-back)
  • Insurance type and network status
  • Missing tooth clause visibility (Yes/No)
  • Downgrade notes (e.g., composite-to-amalgam)
  • Waiting period information

PDF Summary

Automatically generated 4 days before appointments. Highlights key benefits and your priority codes for easy staff reference.

Customization & Benefit Override Options

Every code can be customized under Benefit Override settings:

  • Ignore: FOJI skips updating that code (useful for unused or medical codes).
  • Default: Sets a fallback behavior when portals don't list info.
  • Override: Forces specific behavior regardless of portal data (e.g., always show nitrous as 100% covered).

Templates remove noise codes like COVID or medical codes. Whitelists highlight the office's priority hygiene/restorative codes in PDFs and reviews.

How and When FOJI Runs

  • Verification runs automatically 8 days before scheduled appointments.
  • New or added patients inside that window are verified too.
  • Plans are updated every 90 days unless manually triggered sooner.
  • PDF is generated 4 days before the appointment.

Needs Attention & Troubleshooting

FOJI flags any plan that doesn't confidently map data into Open Dental. Common causes: group number mismatch, patient name spelling differences, portal downtime or invalid response. Staff tools: Verification History Panel in Open Dental, and Session Recordings that show exactly what FOJI did on the portal.

Implementation Guidance for New Offices

FOJI will mirror your Open Dental structure without altering category setups, pull deeper data than a human typically would (including downgrades, waiting periods, and frequencies), allow full control through Benefit Override settings, surface important details such as missing tooth clauses and remaining benefits, and flag questionable data so your team can confirm unclear or mismatched cases.