Outsource Strategies International (OSI) is an experienced dental billing company, providing dental precertification and predetermination services for dental practices for over 10 years.

In today’s podcast, Amber Darst, our Dental Insurance Coordinator, discusses how dental practices can benefit from our preauthorization and predetermination services.

Hey, this is Amber Darst, Dental Insurance Coordinator from Managed Outsource Solutions. Today, I'll be discussing preauthorization and predetermination processes and how it could really benefit your practice to partner with MOS and allow us to handle these back office duties.

"Preauthorization" and "Predetermination" are processes that payers utilize to clearly determine the eligibility for a specific patient to receive certain procedures, medications, or tests. When billing dental insurances for a dental practice, prior authorization is very important. Our dental preauthorization and predetermination services help dental practitioners to -

  • Reduce the risk of your insurer denying payment for the treatments
  • Avoid unnecessary costs for the patient, and
  • Improve practice revenue with on-time reimbursement

Both dental preauthorization and predeterminations are based on the eligibility and remaining benefits at the time it was issued.

So, for the dental pre-authorization process, for any dental practice, certain medically necessary dental services require advance approval 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. An experienced dental precertification company can provide the insurance pre-certification support you need.

01:53 How MOS Simplifies Your Pre-Authorizations

MOS can help with the preauthorization process for all your major procedures. Our experienced billing managers help to obtain preauthorization beforehand to better ensure proper reimbursement.

To simplify your pre-authorizations,

  • Our billing managers send 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 the 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 that your office schedule the procedure while out in advance to make sure that the patient eligibility and coverage are checked before the date of the procedure.

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 a “pre-estimate of benefits” comes in. Managed Outsource Solutions’ 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.

03:28 Benefits Practices Enjoy

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 agents help 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 to the insurer at the earliest time possible.

So, let us work together. Get to know more about our dental precertification and predetermination services. Call us at 1-800-670-2809!

Thanks for listening in!