Improve your practice’s reimbursement process!
"Preauthorization" and "predetermination" are processes that practices utilize to clearly determine the eligibility for a specific patient to receive certain procedures, medications, or tests. At Outsource Strategies International (OSI), we have been providing dental precertification and predetermination services for dental practices for over 10 years.
When billing dental insurances for a dental practice, prior authorization is critical. Our dental preauthorization and predetermination services help dental practitioners to -
- Reduce the risk of your insurer denying payment for the treatments
- Avoid unnecessary costs to the patient
- Improve practice revenue with quicker reimbursement
Dental procedures you perform can include extractions, crowns, fixed bridgework, implants or periodontal treatments.Both dental preauthorization and predeterminations are based on the eligibility and remaining benefits at the time it was issued.
Dental Prior Authorization Process
For most dental practices, certain medically necessary dental services require advance pre-certification and the failure to obtain it may result in claim denial. Precertification, also referred to as preauthorization, is crucial to determine a patient's coverage. Pre-authorization refers to a request for approval sent by a provider’s office to an insurance company to check the patient’s insurance coverage and ensure the treatment provided will be covered. At OSI as an experienced dental precertification company we can provide quick and accurate insurance pre-certification support.
We can help with the preauthorization process for all your major procedures. Our specialists help to obtain preauthorization beforehand to better ensure proper reimbursement.
To simplify your pre-authorizations,
- Our specialist with coordinates with your office and then sends a letter of necessity, along with the claim to the insurer, requesting an approval for the service that has been recommended by the dentist.
- X-rays, charting, and any other supporting documentation will be sent, as well, to further prove the necessity of the procedure.
- After the preauthorization has been submitted, we perform regular follow up calls, checking on the status of the request until an answer has been achieved. The office and the patient will then each receive a copy of the preauthorization determination letter from the payer.
The process to complete a preauthorization can be timely. We highly suggest your office schedule the procedure in advance to make sure that the patient eligibility and coverage are checked before the date of the procedure.
Submitting a Predetermination
At times, dental offices may find that a plan granted preauthorization for treatment but did not receive payment after the claim was submitted. This is when a “predetermination” or “pre-estimate of benefits” comes in. OSI’s dental pre-determination services provide confirmation that the patient is a covered enrollee of the dental plan and the coverage amount that is associated with the procedure.
When any expensive or extensive treatment is being provided, it is ideal to request a pre-treatment estimate. However, predetermination is a formal inquiry of the patient’s eligibility for coverage but NOT a guarantee of payment. By assisting in obtaining a predetermination, our dental predetermination company helps dental offices to receive a notice of patient eligibility in writing, saving your staff’s time.
To minimize claim denials, predeterminations will be submitted on complex, costly procedures from your insurer at the earliest time possible. Our dental billing team also helps submit the claim once treatmentis complete and the claim will include any additional treatments provided as well.
Let us work together! Let us help you improve your office’s work flow.
Get to know more about our dental pre-certification and predetermination services! Call us at 1-800-670-2809!
Steps to Ease the Dental Insurance Verification Process - Podcast by Amber Darst
Hi, this is Amber Darst, Dental Coordinator for Managed Outsource Solutions.
I’ll be talking with you a bit today on the Steps to Ease the Dental Eligibility Verification Process. The office staff at dental practices can get spread pretty thin at times. Patients are coming in, patients are leaving, the phone’s ringing, someone needs to pay their bill. There can be a lot to handle all at once. Then, there is the task of handling the dental insurance verifications. Obtaining these verifications prior to the patient’s appointments are crucial when you are looking to keep a steady, problem-free cash flow. But making sure that these are completed for every insured patient can be quite the headache and very time consuming with all of those other tasks taking up the greater portion of your day.
Here are just a few issues that a dental practice’s front office has to deal with when it comes to verifying benefits.
- The length of time involved in making calls to the insurance companies for benefit verifications for both new and existing patients. Sometimes you can get stuck on hold for long periods of times just trying to verify one patient’s coverage and that can be very frustrating.
- Also, frequent insurance plan changes by employers. These changes happen often and when it does, it leads to an increased number of phone calls that need to be made to obtain all the new coverage details
- Another issue is the risk of insurance misinformation by the insurance rep. You only know what they tell you and sometimes they are not accurate and that’s also very frustrating. You have to be very thorough with the questions that you are asking them to make sure that what you are getting is precise information and up to date information.
- Then there is the amount of time involved in updating the insurance information and possibly even a new fee schedule in the system. So you are now having to take all of this new information and plug it into all the proper places, and that’s for each and every time that an insurance plan changes.So, verifying coverage and benefits is not only important for the practice but it’s also important for the patients as well. They are relying on their insurance plans to help pay for their treatment and they like to know what to expect, what would be their portion of payment before the time they need to come in for the treatment. Here are some tips to help practices streamline their eligibility verification process.
- Set up an insurance file for each patient:Each patient should have their own insurance file with all of the relevant details entered into it. The insurance information should be obtained during the initial call or most definitely before the point of service. Returning patients should be asked if their insurance has changed, and if it has, new coverage and benefits should be verified. Verifying dental eligibility in advance saves time and allows the practitioner to provide the patient with a cost estimate before they visit.
- Calling the insurance company: When you call them directly, it gives you a window of opportunities to ask more questions and obtain accurate and up-to-date information on patient’s benefits. Like I was saying earlier, you really need to be thorough with these questions that you ask to ensure that the information you are being given is precise.
- Document all coverage details: All aspects should be verified and documented such as: the patient’s name, the policy holder’s name and Social Security number, as well as insurance information that you would find on the insurance card. A few coverage aspects to verify include: the percentage by category, frequencies and limitations.
- Communicate to the patients in advance about what’s covered:
Most patients don’t understand their coverage and benefits. Educate them and inform them about the details of the dental service that will be provided during their visit, what the insurance will cover, and what their portion will be as far as payment goes. This helps to avoid the problem of surprise bills. Nobody likes that.
- Also, inform the patient about the claim processing guidelines: Let them know you will be following the service with their insurance, but there is no guarantee of payment. Ensure them that you will be submitting everything to support payment, but it is ultimately up to the insurance carrier to approve the service and pay towards it.So, managing insurance benefits and patient expectations is not easy. Practices have to deal with a large number of insurance plans that are constantly changing. Following the above-mentioned steps can help practitioners effectively manage the insurance process, improve cash flow, and grow patient satisfaction. Outsourcing the patient eligibility verification task to a reliable company can help alleviate the stress and time it takes to get this process accomplished.
I hope this helps, but always remember that documentation and a thorough knowledge of pay regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.
Thanks for listening in!
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