Dental Insurance Eligibility Verification and Compliance

Hi, this is Amber Darst, Solutions Manager here at Managed Outsourced Solutions, and today I’ll be discussing a critical step in the dental billing process.

00:10 Importance of Verifying Patient Insurance Eligibility

Verifying insurance eligibility is essential to determine a patient’s insurance coverage for dental services and their financial responsibilities. It directly affects the reimbursement received by the dental practice. Mishandling or inadequate verification can lead to delays and non-payments, negatively impacting the practice in various ways. There are several challenges that dental practices face when verifying insurance eligibility.

00:45 Dental Insurance Eligibility Verification Challenges

First, accurate patient information is required, including policy details and personal information. Any discrepancies or missing information can delay the verification process.

Second, dental insurance policies can be complex, with variations in the coverage, limitations and exclusions among the different payers. Navigating and understanding the specifics of each plan can be a significant challenge.

Another hurdle that can pop up from time to time is prior authorization requirements for certain dental procedures. This can cause delays as providers and patients wait for the health plan’s approval. This waiting period can impact timely care delivery and create administrative hurdles in managing the revenue cycle effectively.

Furthermore, dental practices often deal with multiple insurance companies, each with their own procedures and systems. Contacting different providers and understanding their specific processes can be time consuming, and obtaining accurate and up-to-date information from them can also be challenging.

01:58 How to Streamline the Dental Insurance Verification Process

 So, given these challenges, just how can dental practices streamline insurance verification and ensure compliance with the regulations?

One practical solution is partnering with a dental eligibility verification expert such as MOS. Our experts have a deep understanding of insurance policies from the various payers and can efficiently carry out the verification process while adhering to regulations and guidelines. These experts will contact the insurance company to verify the patient’s coverage, and this can be done through phone calls, online portals, and or electronic transactions. They will confirm the patient’s eligibility coverage, start and end dates, any limitations or exclusions that may apply, and note the specific dental procedures or services covered under the patient’s insurance plan as well.

Remember, prioritizing insurance verifications before the patient’s date of service is crucial. By partnering with dental eligibility verification experts, dental practices can streamline the process, ensure compliance with regulations, and promote a smooth and accurate dental billing process. Outsourcing this task can alleviate the administrative burden on the dental office staff and ensure accurate and thorough verification.

And that’s all on this. Thanks for listening in.