Save Time and Money by Outsourcing Dental Eligibility Verification

by | Last updated Dec 9, 2023 | Published on Aug 23, 2017 | Specialty Billing

Dental Eligibility Verification
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According to a report in Dentistry IQ, dental insurance checks make up approximately 50% of the income of most dental practices. It is therefore essential that dentists have dedicated and efficient insurance management strategies in place. One of the most important aspects of insurance management is dental eligibility verification. Failure to check patients’ eligibility or the use of incorrect eligibility data are the main reasons for denied dental claims. For new patients, all insurance information should be collected and verified before their visit. Eligibility verification is critical for existing patients too, as patient benefits may change with changes in insurance plans. Outsourcing benefits verification is an ideal strategy to save time and money.

Practices need to communicate with patients in advance about their coverage as most people do not understand their dental benefits. They should be informed as to whether the dentist is a contracted provider for their plan. Dental insurance verification is also essential for providers to get paid. However, verifying insurance can be a big headache for the dental front office. The staff will need to call up the company and spend hours trying to get to the insurance representatives to provide the necessary information. The process will involve verifying plans for new patients, emergency patients, and existing patients. Considering these challenges, practices can benefit immensely by hiring an insurance verification specialist.

Dental insurance verification experts will ensure that patients’ health care benefits cover required procedures before services are provided. This will help improve claim accuracy as well as patient payment responsibilities and satisfaction. These professionals have extensive experience working with insurance companies, and are knowledgeable about different types of coverage and policies.

In order to confirm insurance eligibility of new patients, they will first collect the following information:

  • Patient’s name and date of birth
  • Name of the primary insured
  • Social security number of primary insured
  • Insurance carrier
  • ID number
  • Preauthorization
  • Group number
  • Contact information for the insurance company such as phone number, website and address for claim submission

Once they have collected this insurance information, they will contact the insurance company directly and speak to the insurance rep to verify the following:

  • Whether the patient is covered by the insurance
  • Insurance coverage effective dates
  • In-network or out-of-network coverage
  • Whether they need pre-authorization and/or a referral
  • Whether service(s) to be provided to the patient are covered
  • Coverage percentages breakdown
  • If annual maximum has been met, and how much remains
  • Frequency limitations of exams and x-rays
  • Crown frequency
  • Amount of co-pay for services, if any
  • Deductible amount, and if the deductible been met for the year

Insurance verification specialists also help dental practices update their returning patients’ records. As personal information such as address, contact information, employment, and insurance coverage may change over a short period of time, it is important to verify existing patients’ personal information before each office visit. If there is a change in the insurance of a returning patient, dental eligibility will be checked prior to the office visit.

The benefits of outsourcing dental insurance verification to an experienced service provider are:

  • Eliminates eligibility and benefits-related denials
  • Prevents delayed payments and underpayments
  • Reduces delinquent accounts
  • Saves the time that would go into analyzing and chasing denied claims
  • Provides a comprehensive understanding of the patients’ copayments and deductibles
  • Reduces stress and improves the efficiency of the front office
  • Frees up staff to focus on other important matters
  • Allows the practice to provide the patient with a more accurate estimate before treatment starts
  • Improves collections at the time of service
  • Allows accurate billing of different insurance companies
  • Improves practice revenue and productivity

Dental insurance verification services help providers to be transparent about copayments with their patients. A Physicians Practice article points out that the insurance industry has evolved to place greater financial responsibility on patients. Patients want to know the cost of the services being provided before they are billed for them. Verifying dental eligibility promotes healthcare cost transparency, prevents surprises on dental bills, and improves patient loyalty.

If you are considering outsourcing dental insurance verification, choose a company that can provide personalized services to suit your needs. Reliable companies can provide centralized dental information verification and management on their software or yours. They will verify benefits by calling up the insurance company and by visiting their websites and will contact patients for additional information, if necessary. They will work with your staff to conduct the operation smoothly without affecting your operational efficiency. With a capable service provider, your practice will be assured of accurate information at the start of the claims process and can experience fewer returned claims due eligibility issues, which will improve your bottom line.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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