Dental Insurance Verification Services – Being Prepared Will Maximize Reimbursements

by | Last updated May 24, 2023 | Published on Jun 29, 2016 | Insurance Verification and Authorizations

Dental Insurance Verification Service
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As in the case of insurance verification for many medical specialties, verifying dental insurance is a challenging task. Negotiating with insurance companies is not an easy task and dentists often find considerable discrepancy between reimbursement and claim submission. Partnering with a professional dental billing company that provides comprehensive services to verify patient benefits is therefore a smart move. The team in a professional company would know exactly what to do to help dental practices avoid errors and maximize reimbursement.

Avoid Common Claim Submission Errors

Here are some common mistakes that a reliable insurance verification service can help dental practices avoid:

  • Not submitting proper claims: A reliable dental billing service would ensure that claims are submitted correctly the first time. This will reduce processing time. The team of insurance verification specialists will take the following steps:
    • See that the claim is sent to the right place by calling up the company
    • Send all x-rays, charts for scaling and root planning (SRP), and narratives for major treatments along with the claim
    • in crown treatment, clearly specify whether initial or replacement crown, and if it is the latter, mention the date of the initial placement
    • As some insurers pay on a crown only when permanent crown is seated, this will be tracked and the information submitted as it occurs. Communicating this to the patient and having written and signed financial agreements in place between the dentist and patients will help ensure that patients return for their restoration
  • Not tracking outstanding claims on a regular basis: Experienced benefits verification specialists would know that the best way to track outstanding claims is on the insurance company’s website. This will provide information about the status of a claim such as “unprocessed,” “holding,” “zero pay,” or “rejected”. They will then follow up outstanding claims on a weekly basis.
  • Not appealing denied procedures: It is reported that up to 85% of denied procedures are not appealed, which is a big mistake. Professional dental billing companies will work with patients and physicians to reprocess claims and appeal payment denials. They will resubmit the claims with proper narratives and see that they are reprocessed with payment.
  • Not performing pre-determinations or pre-authorizations: Insurance companies always suggest pre-determinations or pre-authorizations. Though neither of these is guarantee of payment, it provides an estimate of what the insurance company might cover. Pre-determination must be done if the patient requests it or if the insurance company insists that services must be pre-determined before payment is made.

Benefits of Electronic Data Interchange

Established outsourcing companies that provide dental insurance verification and billing services work with insurance companies to identify the reasons for non-payment and correct them. By partnering with a reliable company, dentists can maximize reimbursement and also obtain the benefits of electronic data exchange without having to invest huge amounts in it.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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