You may be wondering what dental insurance verification services Providers are and why they’re important. Read on to learn more about them!
Verifying a patient’s insurance eligibility for current coverage, dental insurance benefits, and prior authorization of operations, from cleanings to oral surgery, falls under the category of dental insurance verification.Four crucial components make up a patient’s insurance plan, including:
– MOOP, or maximum out-of-pocket, cost
An insurance verification specialist in your dental practice should call the patient’s insurance provider before the appointment to verify the patient’s eligibility for dental insurance. Your dental billing department representative can use an interactive voice response (IVR) technology operated by the insurance company to check a patient’s eligibility.
Every week, dental and medical billing departments all around the U.S. and Canada spend hours waiting on hold to complete insurance verification duties. Your dental office can save hours of labour and enhance dental claim clearance rates by outsourcing dental insurance verification to a built-in dental billing service.
A new patient’s insurance claim is more likely to be denied by an insurance company than one for an established patient. Even so, if a dentist doesn’t carry out the proper dental insurance eligibility verification, insurance companies will reject dental claims for current patients.
Your dental insurance billing department or dental insurance verification service will need to confirm a patient’s benefits before a procedure in order to submit an insurance claim for payment and prevent claim denials, regardless of whether Delta Dental, Humana, UnitedHealthcare, or another dental insurance coverage provider provides coverage.
What Exactly Are Dental Insurance Verification Services?
Dental insurance verification services streamline the processes used in your dental practice to confirm benefits and incorporate new insurance data into your patient management system. The dental insurance verification solution integrates with your dental practice software regardless of whether your dental practice specializes in restorative
dentistry, cosmetic dentistry, orthodontics, or family dental treatments.
In particular, when you integrate the dental insurance verification service with your patient communication and office administration systems, outsourcing dental insurance verification to an automated system makes
it simple for your dental practice to manage benefits verification for new customers.
A Comprehensive and Full Benefits Verification Process
You can use this verification form to help you conduct a full and accurate verification process. The patient’s complete benefits must be gathered, and the information must be entered into your practice management system. The most accurate treatment plan will be produced as a result, taking the patient’s financial obligations into account. We advise your team to gather insurance information and confirm all benefits and eligibility when utilizing this system before the patient arrives for their visit.
You’ll need to compile the following data:
– name and date of birth of the patient.
– The principal insured’s name
– The Principal Insured’s Social Security Number
– Insurance company identification number: Group number
– information on how to get in touch with the insurance provider,
including their phone number, website, and mailing address for claims
Although we consider this method to be the most precise, it takes the longest. We are also aware that inaccurate information may come from phone verification with an insurance representative. Be prepared to clarify estimates with solid language skills. Rely on the information you have obtained, but be aware that it does not guarantee payment. In the end, the cost of the care is the patient’s responsibility.
A Shorter, Simpler Eligibility Verification Process
By omitting (or minimizing) the requirement for phone calls with insurance personnel, you can choose to simplify the insurance verification procedure. To construct estimates, you will use data acquired from faxes and websites of insurance companies.
In this case, common estimate guidelines are being used without the time-consuming and exhaustive benefits verification process. To generate estimates, you will input eligibility information into your practice management software.
To lessen the likelihood of disagreement when the patient balance is more than anticipated, we advise you to estimate highly. Your front office staff will need to explain in detail, using a simplified version of the benefits form, that the estimates on the treatment plan are ONLY estimates and that any sum not covered by the insurance company would be the patient’s responsibility.
This strategy takes less time and gives the patient a rough cost estimate. When employing this streamlined, quicker eligibility verification process, we advise you to pre-determine benefits for larger situations.
Streamlined claims and billing procedures will be made possible by organized systems for gathering patient data and determining insurance eligibility. With either approach, you must inform your patients about the restrictions imposed by dental insurance and emphasize your willingness to meet their needs for care while guiding them through the insurance application process.
What Are the Benefits of Contracting Out Dental Insurance Verification Services?
Outsourcing your dental insurance verification to DentalRevu may make it all happen, from taking your mind off the figures to increasing your accounts receivable collections to removing patients’ aggravation over
unexpected additional fees.
We are aware of how challenging it can be to provide patients with high-quality care while simultaneously handling insurance verification and other administrative tasks. As a result, we have developed processes that are astonishingly simplified and a staff of top industry experts.
The combo works very well to handle your patient’s dental insurance verification on the backend, allowing you to concentrate on giving high-quality patient care while remaining calm and committed.
Verification of Eligibility
Patients showing up for dental visits may have recently encountered changes in their employment position due to increasing unemployment rates.
Recoupment issues resulting from retroactive changes to eligibility frequently affect dental businesses. Dental plans have the ability to retroactively update eligibility changes, and provisions in the participating provider contracts allow them to recover payment from the participating dentist when treating a patient who has lost benefit coverage or whose claim was mistakenly paid. Contractually, out-of-network dentists are not required to repay fees made in this circumstance. Payers, however, have deducted money from these dentists’ upcoming payouts.
To prevent future recoupment claims, dental facilities must confirm eligibility on the day of service.
Typically, office personnel will check a patient’s eligibility and coverage via the payer’s web portal or by dialing the toll-free number on their identity card. However, it’s possible that the employer did not promptly notify the patient’s dental plan that the patient’s job and/or associated benefits had ended. This implies that data confirmed through payer portals or call centers could not be current or correct.
The resolution of any subsequent disputes may be aided by keeping a record of interactions with the payer, such as screenshots of the portals with a date and time stamp indicating when eligibility information was accessed or the date and time when a customer service representative was contacted along with the representative’s name. Although payers typically put the onus on the provider by declining to reimburse or by taking back already paid payments.