Documentation Notes
1. Where configuration lives in Foji
Path to benefit configuration UI
* In Foji’s web app:
   * Go to the hamburger menu → Dashboards
   * Choose General
   * Open Benefit Override Configuration
This is the control panel for how Foji writes benefits into Open Dental (coverage %, age limits, which codes to ignore, etc.).
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2. Three core “modes” in Benefit Override Configuration
Each rule you create has a Mode, which tells Foji how to treat specific benefits/codes:
2.1 Default mode
Purpose: “If the portal doesn’t tell me anything, use this fallback.”
* Used when Foji goes to the portal and finds no coverage data for a category or code.
* Without any rule, if nothing is found, Foji sends nothing to Open Dental.
* With Default:
   * You say: “If you don’t find anything, default to X%.”
   * Common use:
      * Default crown coverage to 0% if no coverage info is found.
      * Default age limit to 99 if no age limit is found but staff is used to seeing 99 instead of blank.
Example:
* Portal shows no crown coverage.
* Rule: Mode = Default, Percent = 0
* Result: Open Dental gets a 0% crown row, making it visually obvious that there is no coverage.
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2.2 Override mode
Purpose: “I don’t care what insurance says; always use this value.”
* Ignores whatever is on the portal and forces your chosen value into the plan.
* Typical use cases:
   * Procedures you internally treat as 100% covered, regardless of the portal.
   * Situations where your office policy intentionally diverges from portal wording.
Example:
* Nitrous: office wants to always show nitrous coverage as 100%.
* Rule: Mode = Override, Percent = 100
* Result: Even if the portal says 50% or 0%, Open Dental gets 100%.
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2.3 Ignore mode
Purpose: “Don’t write this data into Open Dental at all.”
You can ignore:
1. Entire codes, or
2. Specific qualifiers (like age limit or frequency) for that code.
Solves:
* Too many codes cluttering the plan and causing decision fatigue.
* Technically correct but operationally unhelpful details.
Examples:
* Ignore specific codes completely
   * COVID-19 vaccine codes, extremely rare procedures, etc.
   * Mode = Ignore on that code → Foji will not push that code into Open Dental.
* Ignore just age limits for a code
   * Guardian fillings with age limits that aren’t followed in practice.
   * Mode = Ignore, Qualifier = AgeLimit (case-sensitive).
   * Result: Foji still writes the coverage % for the filling but omits the age limit.
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3. What you can target with each rule
Each rule in Benefit Override Configuration has fields that narrow what it applies to:
* Code Group – e.g., “Crowns”, “Restorations”
* Individual Code – e.g., D2390, D2391, D2392, D2393, D2394
* Carrier – e.g., Guardian, MetLife, Aetna
* Qualifier – a particular attribute (age limit, frequency, etc.)
* Mode – Default, Override, or Ignore
* Percent – the percentage to apply when using Default/Override
Example meaning:
“For Guardian, on D2391, ignore the age limit but keep everything else.”
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4. The specific filling example (D2390–D2394, Guardian & others)
Problem
* Guardian (and some others) publish age limits on fillings that:
   * Are very technical/legal.
   * Are often not enforced in real office workflows.
Staff reaction:
* They don’t trust those age limits.
* They end up re-verifying manually or skipping Foji and doing it themselves.
Configuration they set up
For resin fillings (D2390–D2394):
1. Open a specific code (e.g., D2390) in Benefit Override Configuration.
2. Set:
   * Mode = Ignore
   * Qualifier = AgeLimit (exact string, case-sensitive)
   * Carrier:
      * Leave blank to apply to all carriers, or
      * Set to Guardian if you want it Guardian-only.
Then repeat/extend for D2390–D2394.
Effect:
* Foji still reads the portal and gets coverage % and other info.
* For these codes, it does not write age limits into Open Dental.
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5. Carrier-specific rules & syntax
Carrier field behavior
* Leave blank to apply to all carriers.
* Or specify one or more carriers, e.g.:
   * Guardian
   * Potentially Guardian, Aetna (comma-separated; exact spacing rules to be confirmed).
Example use:
* Mode = Ignore
* Qualifier = AgeLimit
* Carrier = Guardian
* Code = D2391
Effect: Only Guardian’s D2391 age limit gets ignored; other carriers’ age limits remain.
They also discussed:
* Using carrier-specific rules for ortho age limits, where being wrong is high stakes.
* Foji will send documentation on:
   * Valid qualifiers
   * Case sensitivity
   * Exact syntax (commas / spaces).
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6. Foji’s “overachiever” behavior and why configuration matters
Concept:
Foji is “less software, more service” — like hiring an insurance employee.
By default, Foji:
* Goes to each portal.
* Reads every code it can see.
* Captures:
   * Coverage %
   * Age limits
   * Frequencies
   * Deductibles
   * Maxes
   * Exclusions, etc.
* Pushes that data into Open Dental through the API, using your:
   * Coverage categories
   * Code groups
Issues without tuning:
* Too many codes:
   * Hundreds of lines, including rare codes and things like COVID-19 vaccines.
   * Staff get overwhelmed and stop reading.
* Overly-technical but “correct” data:
   * Guardian examples:
      * Complex age limits on fillings.
      * Bitewing rule where “bitewing on every tooth” flips frequency to something like a Pano/FMX schedule that the office will basically never hit.
Solution via configuration:
* Use Ignore (with qualifiers) to filter out noise.
* Use Default/Override to:
   * Make data match how staff are used to reading plans.
   * Align with how you talk to patients and plan treatment.
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7. How Foji’s verification & benefit refresh scheduling works
Foji has different AI “pathways” for each carrier.
7.1 Eligibility verification
Per carrier (Aetna, Cigna, Delta, Guardian, etc.):
* An AI agent:
   * Logs into the portal.
   * Checks whether the patient has active insurance.
   * Produces a status:
      * Active
      * Not active
      * Member not found
      * Or “attention required” with details.
Timing:
* Automatically runs about 8 days before the appointment.
* Triggers only for patients with appointments in that window.
What you see:
* In Foji under each carrier, there’s a History tab:
   * Shows each run with:
      * Status: Pending / Completed / Failed.
      * Event log of steps taken.
      * A video recording:
         * Screen capture of what the AI did on the portal.
         * Stored for 7 days.
         * Lets you verify exactly what the portal displayed.
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7.2 Manual rerun of verification
Two ways:
* In Foji portal:
   * In History, use the three-dot menu on a run and select Restart to re-run that check.
* In Open Dental (Foji button):
   * Custom program link that passes the patient ID to Foji.
   * Kicks off eligibility/benefit work for that specific patient.
In the meeting, they discovered:
* The Foji button URL was misconfigured for Wynkoop.
* They fixed the path in Setup → Program Links → Foji so the button now works correctly.
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8. What happens during eligibility verification (mismatch handling)
Foji doesn’t just check “active or not”; it also compares demographic/plan data:
Checks:
* Name: Portal vs. Open Dental.
* Group number: Portal vs. Open Dental.
* Address/ZIP: Portal vs. Open Dental.
Outcomes & workflow:
* Wrong group number:
   * Foji flags this in notes.
   * Recommended flow:
      * Copy correct group number from Foji note.
      * Update Open Dental.
      * Hit the Foji button to re-run verification.
* Name mismatch:
   * E.g., spelling differences, nickname vs. legal name.
   * Foji notes portal’s name vs. Open Dental’s.
   * Office decides whether to correct OD.
* ZIP/address mismatch:
   * Critical for MetLife:
      * Can’t find the patient without the correct ZIP.
   * Configurable behavior:
      * Either treat mismatch as a blocking issue or ignore it and only return active/inactive.
   * Wynkoop preference:
      * See all differences (name, ZIP, etc.) so they can reduce claim denials and help their remote biller.
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9. Benefit summaries & remaining max/deductible
9.1 Benefit Summaries in Imaging
Foji’s Generate Benefit Summary agent:
* Gathers plan-level details:
   * Coverage %, frequencies, waiting periods, missing tooth clause, downgrades, in/out of network, etc.
* Produces a document (e.g., PDF) and writes it to:
   * Open Dental’s imaging folder, specifically the Insurance Docs folder (ID 313).
* You can also see the summary in Foji:
   * In the generate benefit summaries pathway, click the run and open the Benefit Summary link.
Issue observed:
* Foji logs show the summary is created and pushed via API.
* The raw files appear in the OpenDentImages folder on disk.
* But in Open Dental’s Imaging module, many of these documents:
   * Don’t show up, or
   * Show inconsistently.
Suspected cause:
* Open Dental folder/indexing configuration (how OD maps folder IDs like 313 to visible nodes in Imaging).
* Foji’s team (Chris) will investigate OD settings to ensure those files are properly surfaced.
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9.2 Remaining Annual Max & Deductible in Family → Patient Info
Foji is designed to update:
* Remaining Annual (max remaining)
* Remaining Deductible
in Family module → Patient Info.
Mechanism:
* On a patient-level eligibility run:
   * Foji gets:
      * Plan max
      * Used amount
      * Remaining
   * Writes:
      * Remaining Annual
      * Remaining Deductible
Important distinction:
* Plan-level updates (benefits) run roughly every 90 days.
* Patient-level eligibility checks (when you care about remaining amounts) run:
   * Automatically within 8 days of the appointment, and/or
   * On-demand using the Foji button.
Current issue:
* Wynkoop isn’t seeing those fields populate.
* The Foji side shows the agent running.
* Likely tied to the same OD integration/path issue affecting benefit summaries.
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10. Playback & debugging tools in Foji
Several tools were demoed for troubleshooting:
1. History tab per carrier / pathway
   * Lists all runs with:
      * Status
      * Timestamps
      * Logs of what the AI did.
2. Screen recording
   * “File”/recording icon for each run.
   * Full video playback of AI’s session on the portal.
   * Useful for:
      * Explaining “member not found”
      * Seeing if portal layouts changed
      * Verifying what was on-screen vs. what Foji extracted.
3. Search bar in History
   * At the top of the History page.
   * Can search by patient ID to pull all relevant runs.
   * Helps answer:
      * When was this patient last checked?
      * Which carrier did we verify?
      * What was the result?
4. Restart
   * Three-dot menu on a row → Restart.
   * Requeues that verification/benefit job if:
      * Portal was down.
      * There was a temporary failure.
      * You’ve just fixed data (like group number) and want a fresh run.
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Summary
* Foji pulls detailed benefit and eligibility data from payer portals and writes it into Open Dental.
* The Benefit Override Configuration screen controls how Foji writes that data, using three modes:
   * Default: Fill in values when the portal does not provide anything.
   * Override: Force a specific value and ignore the portal.
   * Ignore: Hide entire codes or specific details such as age limits.
* Rules can target specific codes, code groups, qualifiers like AgeLimit, and carriers. The Carrier field is a single portal value. You create separate rules when you want different behavior per carrier.
* Offices often use Ignore with AgeLimit on fillings (for example D2390–D2394) to stop confusing age limits from showing in Open Dental while still keeping coverage percent.
* Foji runs automatic eligibility checks for upcoming appointments about eight days before the visit. Results and logs are visible in Pathways → History, with screen recordings kept for seven days. You can rerun jobs from History or with the Foji button in Open Dental.
* Foji flags mismatches such as group number, name, or ZIP between Open Dental and the portal. Staff should correct these in Open Dental and rerun verification to reduce claim issues.
* Foji can generate Benefit Summaries into the Imaging module and update Remaining Annual Max and Remaining Deductible in the Family module when patient level verification runs.
* For troubleshooting, use History, screen recordings, patient ID search, and job restarts. Contact Foji support if data appears in Foji but not in Open Dental.