Dental Eligibility Verification improves collections from insurers Dental eligibility verification is a step toward better outcomes, and Capline shares five tips to streamline and accelerate the process.
The fast-paced dental industry requires smooth dental eligibility verification to reduce denials and speed up claim approvals. Dental insurance verification companies like Capline Dental Services streamline the process and lay the foundation for improving the billing process. A successful practice enhances the patient experience, protects the financial health, and reduces administrative distractions.
Verifying prospective dental insurance coverage ensures that the provider and the beneficiary are fully informed about what their insurance will cover for routine cleanings and other dental procedures.
Getting the dental insurance verification right is crucial. If there is an error, the patient could face an unexpectedly high bill, leading them to question why the dental office did not confirm the costs beforehand.
Failing can lead to costly outcomes. If the dental practitioner performs services outside their coverage, the insurance company will reject the claim, leaving the practice without reimbursement. The statistics state that dental eligibility verification is always an area of improvement because 50-60% of front office time is spent verifying eligibility. It is worth stepping back and working with Capline Services to fine-tune the process and give patients sufficient time, leading to enhanced patient care.
Here are five ways to properly function the verification process that speed up the reimbursement from the insurer by eliminating denials and reducing the out-of-pocket expenses, leading to happier patients who keep coming back.
When patients book appointments over the phone, the dental office staff should gather their insurance information immediately.
As per the American Dental Association, with rising unemployment rates, the patients attending dental appointments have recently experienced changes in their employment situations. This proactive approach provides time to check their active benefits and anticipate recoupment situations.
This two-day window allows the front office team to thoroughly review their benefits on the website, comprehend the details, and identify any need for additional information from the patient before their visit. Responding to inquiries might linger.
Failing to verify insurance benefits in advance can lead to complications. For instance, if a patient arrives for their appointment without prior clarification,
• They may be faced with an unexpected bill, an avoidable outcome, and
• It can lead to patient dissatisfaction.
It’s essential to clear up insurance details before the visit for a smoother experience for everyone involved.
Streamline the insurance verification process by creating a dedicated form to transcribe insurance information as the patient shares it.
Here is the essential checklist of data to include in the form:
• Name of the insurer
• Beneficiary ID number
• Beneficiary Date of Birth (DOB)
• Employer’s name
• Group ID number
• Insurance company’s contact number
Creating an online form is also advantageous. It’s simple to update whenever the patient’s insurance information changes.
When the team accesses the insurance portal to verify the active benefits, they review the detailed summary of their insurance plan. This summary provides a comprehensive breakdown of their benefits, including which dental procedures are covered, the coverage percentages, any benefits the patient has already utilized, the maximum limit of their plan, and other critical coverage details.
Having this full breakdown is essential for verifying dental insurance. It empowers the dental office to inform the patient about their financial responsibilities. It accurately anticipates what the dental practice can expect to collect from the insurance claim submission.
Additionally, confirm patients at every appointment if their dental insurance has changed to ensure the practice has up-to-date information.
When umbrella coverage is in place, utilize the same dental insurance information for all family members.
When a parent contacts the clinic to schedule a dental appointment, confirm that the child is covered under the same plan as the parent. If they are, the dental practice can promptly verify their insurance coverage without needing a breakdown of benefits.
Additionally, for new child patient appointment requests, verify whether the child is covered by the same policy, eliminating the mistake of denials. Do not assume anything, as the corresponding benefits have been terminated.
Does it sound confusing and complicated, which can distract the staff from patient care? Collaborating with Capline Services helps increase profit and focus on patient satisfaction.
For instance, when a patient returns and their insurance has remained unchanged for the year, it is crucial to verify their coverage details. The dental staff has to confirm that they still have the same benefits and are eligible for coverage.
What if they’ve reached their annual maximum? Many patients don’t realize they have remaining coverage dollars that could go unused, so it’s important to remind them to address their dental needs while coverage is available. Insurance benefits are not transferred to the upcoming year, so it is best to take advantage of them now.
ADA suggests participating in the Unified System for Eligibility and Benefits Verification to understand the pain points of dental offices.
What is the reason for not receiving accurate eligibility and benefits information? According to CAQH, the dental industry stands to gain over $760 million in cost savings for eligibility transactions. This represents a substantial opportunity for improvement and efficiency in the sector.
For instance, the dental office must ascertain whether a crown is covered by an in-network provider on tooth number X for the service date and identify the associated patient charges for this procedure. This situation leans toward a pre-treatment estimate rather than merely eligibility/ benefits verification.
It highlights the essential issue the ADA is addressing. The ADA is not attempting to encroach upon prior authorizations and recognizes that annual limits or consultant reviews can influence final payment determinations.
