Common Challenges in Dental Eligibility Verification and How to Overcome Them

Common Challenges in Dental Eligibility Verification and How to Overcome Them

Over the years, multiple studies have indicated that patients did not seek dental care due to expenses, fear, appointment times, or even being unable to find a dentist who accepts their insurance policy.

A key task that faces a dental practice today is dental insurance verification. Eligibility verification is vital for the practice as well as for the patient. Most patients depend on insurance coverage to support payments for treatment rendered.

Challenges in Dental Eligibility Verification

Some challenges that dental practices face when it comes to the insurance eligibility verification process are listed below.

Lack Of Accurate Information

Obtaining precise information about the plan and details of a patient is a key challenge. Patient details that are incorrect and that happen due to outdated records or human error generally can lead to a rejection of claims and consequently a delay in payments.

Need For Documentation

This challenge can be overcome in simple steps. Setting up an insurance file for every patient is a must. The file should contain all the pertinent details of the patient and the plan in it. Details of insurance plans shared by the patient during the initial calls can be entered in the file.

Existing patients who come for treatment again need to share details about their insurance. If there are changes and additional coverage or benefits have been added, then the same needs to be verified. For every patient, the procedure codes used most often as well as other important details can be captured in the practice’s insurance verification form.
A good option would be to club all patients with the same insurance plan together. One needs to note that the verification for insurance eligibility before the commencement of treatment saves time and trouble later on. The dental team can also share a cost estimate for treatment when the patient arrives at practice.

Intricate Policies

An easy comprehension of insurance policies and coverage is a challenge. Insurance policies are quite complex and come along with multiple coverage limitations, exclusions, and variations.

How to Overcome Eligibility Verification Challenges

Now let’s talk about how you can overcome eligibility verification issues. Here’s a breakdown of the solutions-

Confirmation Of The Plan And Coverage Details

The dental team must get in touch with the insurance organization and gather precise and updated information about the plan and benefits of the patient.

Key insurance eligibility elements need to be verified and confirmed. These include the name of the patient, name of the policyholder, social security number, policy number, and the insurance organization among other details. Finer details of coverage aspects that need confirmation include the percentage of coverage by category, cleanings, tooth implants, x-rays, crowns, etc.

The practice can also use electronic health records and integrate them with insurance databases. This will make the validation of insurance details and coverage accurate while also streamlining the verification process.

Managing Communication Barriers

The dental team needs to contact insurance organizations to verify coverage details and attain clarification of any queries. This task can be a challenge due to extended wait times or if accessibility is limited.

Research reports over the years indicate that a sizable majority do not completely understand their insurance policy details and corresponding benefits. Very few patients understand terminologies such as co-pays, deductibles, or co-insurance.

Connecting With The Patient

There is a need to communicate in advance about what services and treatments get coverage and to what extent as not all patients understand their plan coverage, other benefits, and out-of-pocket expenses. A clear explanation of all costs and insurance coverage regarding treatment can avert any misunderstandings.

The dental team needs to educate the patient on all policy details, extent of coverage, deductibles, etc. The patient needs to be informed about any financial liabilities or upfront payments that need to be made by the patient as this will aid in avoiding any surprises once the treatment is over.

The team must notify patients as to how claims get acted upon and processed even before the initial appointment. An effective way to share these vital details is to capture all policy details on paper and ask for an acknowledgment by the patient. This signed paper can then be filed with the patient’s document history.

Connecting With The Insurance Company

The dental team must maintain open and transparent communication channels with the insurance organization. This is useful for a speedy resolution of possible disputes as well as for faster processing of claims.

The team needs to proactively join forces with insurance organizations to quickly resolve issues regarding claims. It also includes sharing all relevant documents and responding to any queries that the insurance company might ask for.

Handling Sensitive Data And Compliance

The dental needs to handle the personal details of a patient during the insurance verification process as it comprises handling sensitive patient details. In addition, adherence to regulatory norms can raise concerns regarding data security and other compliance protocols.

Putting Data Security Measures In Place

The team needs to develop and implement a comprehensive data security plan that includes encryption, and access controls that can protect vital patient information during the verification process.

Regular audits need to be undertaken to confirm if measures are being effectively implemented.

From a compliance perspective, ensuring HIPAA regulations and other applicable standards governing the handling of protected health information are followed is critical.

Managing Procedures That Are Time-Consuming And Cumbersome

If the team is engaging in manually verifying the insurance details of a patient, this can be cumbersome and consume valuable time for the team. This can lead to delays in scheduling appointments and patient care while also creating administrative inefficiencies.

Automation And Electronic Claims Submission

The practice can consider the deployment of automated solutions that can drastically lower the time and effort needed for insurance verification. Electronic eligibility verification systems and real-time claim settlement tools minimize errors while also offering quick access to precise insurance details.

Automated systems might not be able to address a complex situation that requires prior authorization or data that cannot be verified automatically. A manual intervention is then necessary to ensure an accurate assessment of coverage details.

Conclusion

The process of insurance eligibility verification can be challenging but efficient processes and investing in team training can help a practice in overcoming such challenges. Effective eligibility verification helps facilitate smoother operations and prevent denials. Outsourcing these crucial requirements to an experienced insurance verification company can enhance the process while allowing the practice to focus on patient care and improving the customer experience.

Related Posts

Follow Us For More!

Connect with us on our social media handles for industry insights, service updates, and tips to optimize your healthcare practice.
magnifiercrosschevron-down