Are you looking for how to verify your dental insurance coverage? You’re not alone. In fact, many people have questions about their dental insurance coverage.
Let’s imagine you had a positive interaction with a patient and are confident in your ability to deliver a positive patient experience. If you learn that your patient’s dentals insurance verification information was incorrect and your claims were rejected, all of that excitement might come crashing down. This negative outcome can be prevented with proper insurance verification prior to a patient interaction. The verification process is not nearly as difficult as it is frequently implied, which is good news.
What is insurance verification?
The practice of confirming a patient’s insurance benefits and coverage before an appointment is known as insurance verification. The process of ensuring that a patient’s insurance plan covers the services you offer and is in your network is more crucial.
In some medical offices, to verify dental insurance which is handled by the front desk employees. In this situation, verifying dental insurance can take up a shocking amount of a staff member’s shift. You can contract with independent medical billing organizations to verify dental insurance if you’d rather give your front-office employees plenty of time to speak with patients. You can choose which business, whether it’s the user-friendly Karee or the highly configurable Advanced, might be best for you by reading our reviews of the top medical billing and coding services.
The significance of patient health insurance verification in medical billing
Whether you have been in practice for a while or are just beginning, to verify dental insurance is important.
Denials of claims are reduced: Assume that you still have a patient’s insurance information from the previous year and that it hasn’t changed. Your claims may be going to the wrong payer if their insurance has changed. Naturally, the outcome is an immediate claim denial. In order to refile the claim with the correct payer, you must get in touch with the patient to find out who their proper insurer is. Even so, the time and money you spent working on the first claim are already gone.
Cash flow is maximized: Your cash flow is also improved by the decrease in claim denials that comes from dental insurance verification. Consider this: Fewer denied claims equate to more granted claims, which results in faster payment of more money. You’ll visit the insurer with accurate information about all of your patients.
Patient satisfaction rises as a result. All of us have experienced this: We went to the doctor for medical care, but we ended up spending far more than we anticipated. Your insurance ought to have paid for everything, right? You have the authority to stop things like this from happening as a practitioner who treats patients. To Verify dental insurance verification before the patient’s appointment, just confirm their insurance and then let them know what it does and doesn’t cover. Patients avoid any costly surprises this way.
What distinguishes an insurance verification from an insurance authorization?
Insurance authorization differs from dental insurance verification in that it involves securing an insurer’s consent for specific services. Insurance verification entails verifying a patient’s insurance information. The procedure for preparing and submitting medical claims is distinct from this approval. Instead of a retroactive motion for payment, it is a sort of prior authorization for services.
Insurance authorization can be necessary if your patient needs particular treatments, drugs, or tests. Although different payers have varied regulations governing when authorization is required, they all typically want to accomplish the same thing: to ensure that payer funds are used for completely necessary, high-quality services..
Some patients could additionally need insurance pre-authorization for every single visit to a specialist. A referral from a primary care physician often fulfils this need.
The procedure for verifying dental insurance
Do the following to verify dental insurance of patient:
- During registration and intake, gather patient insurance information.
When was the last time you came across a registration or intake form for a patient without a section for the patient’s insurance details? When was the last time you overheard a patient being asked for their insurance information when setting up an appointment? You probably have no idea how to respond to either query, or perhaps the answer is just never. There’s a reason behind that. Your verification procedure can begin right away because you have access to a patient’s insurance information.
Obtaining patient insurance information at intake involves more than merely inquiring about the patient’s insurance provider. Obtaining the patient’s insurance ID, policy number, and group number, if relevant, is also necessary. A phone number that providers can call should also be on the patient’s insurance card. This number should also be written down.
To Verify dental insurance verification, you should also confirm whether the patient or another party is the policyholder. Be careful to note the patient’s relationship to the policyholder as well as their entire name. You’ll have all you need if you combine the patient’s full name and birth date with all the insurance data you’ve gathered.
Your medical practice will gain a major benefit from collecting an accurate record of patient demographics, including quick and efficient check-ins, insurance verification, and the reduced work required for recordkeeping.
Communicate with the patient’s insurance provider.
Once you have the patient’s details, get in touch with the insurance, whether you have a great working relationship with them or have never dealt with them at all. Since insurers provide coverage for so many individuals, it may take them a few days to acknowledge and respond to your request for verification.
Start by calling them to introduce yourself. When a representative answers, dial the patient’s dental insurance verification company‘s number that you have on file. Call back later if you find yourself on hold for what seems like an eternity with an dental insurance verification company.
As soon as you interact with an insurance representative, be sure they have the right to confirm a patient’s insurance information. Next, confirm with the representative that you are transmitting patient information over the phone in a HIPAA-compliant manner. After that, provide the patient with access to the insurance data you have gathered. For advice on how to do this successfully, see the following step.
To Verify dental insurance verification, check the patient’s coverage and benefits, several insurers have online portals where you may enter the patient’s information. The findings of your verification could be unreliable, though, as these websites are known for being out-of-date. Thus, phone calls are usually the best alternative for verifying insurance, but in an emergency, internet portals might be a respectable substitute.
Conduct the appropriate inquiries.
Now that you have an insurance agent on the line and your patient’s insurance information close at hand, you are prepared to comprehend the specifics of their coverage and perks. Have the representative first confirm all the information you have gathered. Find out the policy’s status and expiration date next. If the insurance is still in effect, you should ask the insurer what the patient’s copay will be. Information about the patient’s deductible should also be gathered.
The essentials of your patient’s insurance policy will now have been confirmed, but you shouldn’t stop there. You must now decide whether any insurance authorizations are necessary before seeing the patient. As you inquire about these requirements, be sure to enquire about any additional documentation needs or unusual coverage limits. Finally, ask any questions you think are pertinent to this particular payer using your prior experience.
Start from the top before every patient encounter
The entire process is divided into the three steps indicated above in order to dental insurance. However, patients are theoretically free to switch plans or lose their insurance whenever they want. It is best to ask the patient about their insurance coverage before every appointment or to offer rewards via your company’s patient portal. Whether it has been a year or a week since your last visit with the patient, this concept is still relevant.
Do not just ask the patient if their insurance has changed because this does not provide them the most current information you have about them. Instead, present them with all the information you have and ask them if it is accurate or needs to be updated. If the patient affirms that the information you gave is accurate, your dental insurance verification process is complete. If not, start from the top and don’t skip any steps. Your cash flow, claim denial rates, and patient satisfaction are all at risk.