Which is the Better Dental Insurance Verification Option – Using Software or Calling the Company?

Hi, this is Amber Darst, Solutions Manager here at Managed Outsource Solutions. I’ll be discussing today – which is the better way to complete your insurance verifications– using a software or hiring a dental eligibility verification specialist to focus on this task.

If your dental practice accepts insurance, implementing an effective and affordable dental insurance verification process is one of the most important steps to ensure a smooth patient experience and maintain a steady flow of revenue. In fact, insurance verification is the first crucial step in the patient intake and dental billing process.

If you are worried about accuracy of your claims and avoiding denials, checking the patient’s active coverage and determining their responsibility before their appointment day is crucial.  With so many insurance plans and a variety of fee schedules and coverages, staying up to date with the patient’s benefits can be a major hassle.

01:13 How to implement dental insurance verification

So, how do you do it?

Well, these are the two most common options.

First you can have a dedicated dental insurance verification specialist complete the verifications or you can use a dental insurance verification software. So, between these two options, it seems simple to use the dental eligibility verification software, right? While the software normally claims to provide services such as real time verifications, reduced delays, prevention of errors and more, just how dependable is the process? Although it may sound like a quick and effortless way to retrieve the benefit information, our research has found that verifying insurance benefits through a software program does not guarantee you all the details that you need to make sure you get paid, and that can actually lead to some major inaccuracies and inefficiencies .

02:12 Problems of using software for dental insurance verification

Here are some concerns that have been voiced by dental offices that have used these platforms.

• Software verifications can typically only provide 50% of the information that is needed to be considered a full breakdown of benefits. The office staff would then be left retrieving the remaining benefits which is not much of a time saver when you end up having to make that call to the insurance company anyway.
• Then with certain insurances, comprehensive information is not always available. There are major limitations for what the software can provide. They do not utilize any other pathways such as insurance web portals or fax backs or any other resources that are needed to retrieve pertinent remaining benefit information.
• Software platforms also do not customize their forms to suit your needs. They offer extremely limited standard forms. They only provide the benefit information within their format and guidelines. If the provider requires extra codes to be verified, they must do this on their own.
• The software only provides a PDF within the benefit information retrieved. Automated systems do not update the coverage tables or add any extra notes that are specific to the patient or the plan within the provider software.
• They do not always provide accurate information on stipulations with certain procedures and waiting periods. This also can be a costly oversight for both the patient and the provider.
• The eligibility information is not incredibly detailed. As an example, they would not be providing the extended coverage information applying to services such as periodontics or prosthodontics.

So, with all these limitations, it is difficult to safely say that using a software for automated insurance verification is the most efficient way to get comprehensive coverage information. If you are one of those practices that require only basic information, this may work for you.

Now let’s take a look at the other option of hiring a full time specialist for outsourcing the dental verifications to an experienced dental billing company.This method ensures that your office has a dedicated eligibility expert working on your verifications, providing a full breakdown of individual insurance benefits. Now you can receive customized verifications according to the exact codes, frequencies, histories and limitations that would apply to your specific practice and services provided.

05:03 Benefits of hiring an experienced insurance verification specialist

An experienced insurance verification specialist will verify all the details before the point of service making sure that you know everything you need to know before you see the patient such as – the annual maximum, co pays and deductibles missing two clauses or other limitations, coverage for orthodontics, frequencies and histories, the effective end termination dates and comprehensive information such a specific code coverages and out of pocket cost. Also they can call when the information required is not available on the company’s website, which is roughly 90% of the time. If you want to take it a step further, some of these dental insurance verification companies can even help with other back office duties such as pre-authorizations, A/R follow up as well as billing and collections.

Overall, outsourcing your dental insurance verifications will help streamline the process, save your staff’s time, ensure accurate information for the claims filing, and prevent the denials due to eligibility and coverage errors.

So one major question normally is – is it more expensive to have the dedicated eligibility verification specialist than using the software. Most often, yes, but the return of the investment makes up for that expense – 2 or 3 properly verified bridges or tooth replacements will cover that cost. Imagine if you get that wrong. Getting your coverage tables updated and all of your practice’s custom forms properly filled out pays for itself. After all being prepared is better than having to go back and fix it later.

06:55 So, the bottom line

Dental insurance verification is a very tedious process that is best managed by a personal resource versus relying on a digitized software. You do not want to end up with several claim denials because the software could not clarify the comprehensive list of benefits ahead of the treatment.

Here at MOS, we believe customizing to our clients exact needs is the only way to ensure your verifications are done timely and efficiently. A software just can’t provide that level of tailor-made services.

And that’s all! Thanks for listening in.