How to Ensure Efficient Dental Insurance Verification and Claim Submission

Hi, my name is Loralee Kapp, the Solutions Manager with Managed Outsourced Solutions. Today, I want to talk to you about how to ensure efficient dental insurance verification and claim submission.

Verifying dental insurance is an important step in the billing process. This will ensure that the services rendered and billed will be covered. Incorrect insurance verifications lead to almost 75 percent of dental claims being submitted with errors. A reputable billing company can provide a peace of mind for providers knowing that their verifications are being completed accurately.

00:33 Measures to minimize claim denials
 There are a few measures that can help minimize claim denials.

A primary tip is to take all the necessary efforts to correctly send the claim through cleanly the first time. Well, this seems obvious. Often the claims submitted are incomplete. To ensure complete claim submission, verifying benefits can tell you what exactly will be needed to claim revenue.

Make sure to send X-rays connected with implants, crowns, pre and post procedural root canals, root planning and scaling. For scaling and root planning procedures, a perio chart is required. For any major treatment, you will need to include narratives in the clinical chart for easy accessibility. In a claim submission you only have 150 characters for remarks in the Unusual Services Section.

It must be documented to mark either initial or replacement. Replacement crowns must mention the exact date of the initial placement. Unless the initial placement date is provided, the claim will be denied. It is also important to verify coverage as many insurance companies only pay for crown placement after the seating for the permanent crown, making it vital to track the stages to submit updated information as soon as the permanent seating is done.

By tracking claims on a week by week basis, you know that the clearing house usually provide status updates after claim submission. Reviewing these reports can give you valuable insight on the claim’s status and the reason why the claim may have been processed in an unsatisfactory manner. Checking the clearing house updates can provide you with information faster than waiting for the EOB, as they may take up to 30 days to process.

Statistics show that 85 percent of denied claims are not appealed which is a big mistake. A 75 percent of claims that are appealed are re- processed and paid. By outsourcing to a reputable billing company you can rest assured that your claims are being sent with appropriate supporting documents followed up on and appealed within a timely manner. For this to happen, a comprehensive insurance verification is required. This includes verifying effective coverage dates, codes specific to procedures being performed, waiting periods for certain procedures, plan type and fee schedule, deductibles and maximums, documentation required, claim submission info such as phone number, address, payor ID and fax number, coverage percentage by category, tooth implant, grafting crowns, cleaning and build-up coverage, frequency of X- rays, missing tooth clause, and last date of the service.

Knowing these answers prior to the visit will instill your patient’s trust in you and allow for patient responsibility upfront. Relying on an outsourcing company brings experienced professionals on to handle the various demands of verifications as well as speeding up reimbursement due to clean claim submission.