Dental Insurance Billing & Collection
Known to be a renowned dental insurance billing and collection company based in Houston, Capline Dental Services is your comprehensive resource to eliminate all of the undue stress that can be caused by decreased collections and high accounts receivables.
Hiring a professional Dental Billing and Collection Services Company can greatly reduce this problem in your practice, making the constant headache of collecting fees a distant memory. When you choose billing specialists at Capline Dental Services, you are investing in a service that can handle both simple and complex insurance and collections challenges, resulting in increased efficiency and profitability for your practice.
At Capline Dental Services, our mission is to collect all of the insurance money owed to your office. We address your dental billing issues using a fully developed methodology. Our professional experts work at each stage to move towards an efficient insurance claim process.
- Daily Processing of Primary and Secondary Claims
- Using Clean Claims Tool to Check for Accuracy of Claims before Submitting to Insurance
- Claims Correction and Re-Submission
- Claims Management and Tracking (Aging)
- Insurance Payments Posting and Adjustments (if required)
- Follow-up with Insurers and Appeal of Denied Claim
- Periodic reports that show how your practice is doing at
- Patient Statements (Add on Service)
Dental Billing and Collection should be accurate and efficient in order to facilitate smooth cash flows for every dental practice. However, this is not always the case with all dental practitioner as long after the patient has received the treatment the practice can still find itself chasing the payment from the insurance provider.
This is why it is important for any dental practitioner to hire the right staff for smooth billing and collection.The right team of professionals are well aware of all the different codes for dental procedures to file the right paperwork for all your claims thereby ensuring maximum payable benefits for your practice.
We at Capline Services are committed to provide a great dental billing and collection experience for all the dental professionals who we get associated with.
Dental Billing Services We Offer
We provide a range of dental billing services that make it easier for any dental practice to collect what they are owed. Our thorough process includes:
Dental Billing Eligibility Verification
Crucial information pertaining to deductibles, co-insurance, effective policy date and other coverage details are collected for efficient dental billing eligibility verification. We verify all this information so that we know that the claim that we are filing for payment is 100% eligible.
It is one of the most important aspects of dental billing as only when the invoices, case files and other relevant documentation are vetted can they be used to fill the information in the claim.
It is essential to enter data systematically after it has been vetted. Information like demographic details of patients, dentist details, code sets used among other needs to entered in the right manner. At Capline, our experts are well versed with the latest billing softwares that assist in data entry and processing of dental claims.
Dental Claims Processing
Dental Claims processing can become quite a long and difficult task if not handled properly. Since it requires strict cross checking of essential information which should be in compliance with the existing protocols the claims should contain verified information in the right format for hassle-free approval.
Maintenance of Accessible Data Repository
We maintain an easily accessible data repository which includes explanation of benefits, patient information, insurance coverage information as well as the treatment undertaken. Since all the data with respect to previous claims is stored properly it helps in quick retrieval of information necessary for instant cross verification. Moreover, the data is kept confidential and is only shared with approved insurance carriers and can also be requested by clients.
Explanation of Benefits (EOB’s)
We share detailed explanations of benefits that contain necessary information about the amount the healthcare insurance provider paid as well as the payment patient is responsible for if any. Other items included in EOBs are deductibles, co-payment options as well as items excluded from the insurance plan.
Pre-authorization is the process of getting prior approval from the insurance company as well as what the estimated cost of treatment for the patient is going to be.This helps both the patient as well as the dental provider learn beforehand what the insurance company will reimburse and is quite useful in getting maximum insurance benefits.
Our coding experts are well versed with all the information with respect to the Dental Terminology in use.This helps us use the right codes for each dental procedure in the insurance claim for faster processing.
Claims Denial Management
If for any reason the claim gets denied our team helps you identify the error quickly and correct it immediately to appeal the claim denial and get the settlement promptly. We take care of incorrect spellings, missing data, invalid service codes among others.
Online Tracking of Claims
We provide online tracking of claims which always allows the patients to check the progress of their application.
Dental Billing Processes we follow
We help dental practitioners get quick payments only because we follow an effective step by step guide for dental billing and collection. Our teams are available for you at all times to resolve all your queries and document all the claims in a way that they are easy to access at all times as well as easy to transfer in case you have decided to switch providers. Below are the steps that we follow:
Why Outsource Dental Billing and Collection
to Capline Services ?
Dental billing and collection is something that can prove to be challenging to anyone time and time again especially if the company is new. At capline services we have a team of experts who have been working in this area for quite some time and have the right solutions to every challenge which can easily prove to be overwhelming to others. By choosing us you get a range of services like :
We provide adequate screening of claims as they are scrutinized by our team of attentive experts.
We use softwares that provides predictive analysis of each and every claim.
We make sure that you pay the best rate in the market so that you get the best of both price and quality.
Data Security and Confidentiality
We follow all the terms and conditions of non-disclosure agreements which is why your data is confidential information.
Our advanced software is able to collate all the information you have in your system together.
We comply with all HIPAA guidelines and standards which help fastrack our claims.
All round support
Our teams of experts provide all round support at any time be it for a clarification or to know the status of your claim.
Flawless coding and documentation
We have all the dental codes on their fingertips which is why we are able to implement the right coding successfully.
Outdated Dental Billing
INADEQUATE STORAGE SYSTEM
A lot of dental billing companies still rely on paperwork and file cabinets to store information and documents related to claims.
LONG DURATION PAYMENTS
When a claim has been pending for a long time it directly impacts the cash flow of a dental practice thus negatively affecting the revenue cycle.
Correct coding is the backbone of each and every successful dental claim but with so many companies promising correct coding there are so many who are unable to deliver as they do not employ coding experts.
Every dental practitioner feels some amount of stress at their workplace related to patient care as well as administrative work if they are actively involved in both.
POOR PATIENT EXPERIENCE
Patient experience doesn’t just involve getting first class treatment as it also includes getting on time updates related to claims as well as detailed patient statements which a lot of practices don’t send.
Capline’s Ultimate Dental Billing Approach
USE OF ADVANCE SOFTWARE
Our software is easily able to collate all information related to a single claim in one place electronically resolving issues along the way for efficient results.
We at Capline have a team of dental billing experts who ensure the claims are filed correctly so that payments are made on time to the dental practice.
We have a team of coding experts who are well versed with all the codes currently in use which is why they are able to fill the right ones as per the dental procedure and treatment received.
GREATER EFFICIENCY AND NO STRESS
With our hassle free process of clean claims submission, regular follow ups and timely payment posting we leave you to what you do best i.e. treat patients with all your energy.
ENHANCED PATIENT EXPERIENCE
In order to provide enhanced patient experience to each and every patient you need the best of both dental care and dental billing. We are here to implement the latter as you take care of the former.
Our team at Capline Dental Services works round-the-clock to provide clients with the updated detailed reports of the Billing & Collection process on a weekly and monthly basis. We also specialize in generating on-demand reports to keep them updated on their practice revenue at all times.
1. Monthly Claims Submission Progress and First Pass Ratio – Sample Report – Jan 2023
This report gives a brief overview of Total numbers of claims which were received and billed along with the number of claims which were clean or fixed for the month.
- Claims in Dollar Amount
|As on Month End||Received||Billed||Found Clean||Fixed and Submitted|
|First Pass Ratio||Pending|
- Claims in Numbers
|As on Month End||Received||Billed||Found Clean||Fixed and Submitted|
|First Pass Ratio||Pending|
2. Monthly Production/Collection/Adjustments/AR Report – Sample Report – Jan 2023.
This report includes the estimated production of a month with the total collections from insurance, adjustments as well as the Outstanding AR amount in that month
|As on Month End||Est Production||Collection||Adjustment||Outstanding A/R|
3. Collection to Production Ratio (With Matched Months) – Sample Report – Jan 2023
This report indicates the collection, adjustment, Bill to Patient and In process (AR) amount against the Estimated Production amount of each individual month.
|Month||Total Est Amount||Payment Received from Insurance||Billed to Patient||Adjustment||In Process (AR)||Total|
|$ value||%age||$ Value||%age||$ Value||%age||$ Value||%age|
**Report will be furnished only if we are able to fetch it from your Practice Management Software
4. Month-on-Month AR Progress – Sample Report – Jan 2023
In this report, we provide you the historical month wise comparison of your "Outstanding A/R". It also shows the current age-wise status of the claims with the complete count.
|As on Date||0-29 Days||30-59 Days||60-89 Days||90+ Days||Total|
|Dec 31, 22||$26,779||117||$9,404||36||$5,673||31||$9,236||40||$51,092||224|
|Nov 30, 22||$13,832||56||$8,097||42||$6,513||24||$12,682||74||$41,124||196|
|Oct 31, 22||$17,110||95||$11,424||52||$3,946||25||$11,598||80||$44,078||252||Sep 30, 22||$17,987||80||$8,898||51||$1,987||17||$8,088||65||$36,960||213|
|Aug 31, 22||$15,963||92||$5,534||30||$1,214||11||$9,462||64||$32,173||197|
|Jul 31, 22||$19,879||82||$4,757||32||$2,012||11||$21,987||130||$48,635||255|
|Jun 30, 22||$2,169||19||$5,133||21||$4,587||13||$28,150||152||$40,039||205|
Frequently Asked Questions – Billing & Collection Service
- Run Utilization, Procedure Not Attached to Claims Reports in Dentrix.
- Submit all claims with x-rays, narratives and other attachments daily (every claim will be billed immediately)
- Goal is to bill all claims accurately and promptly.
- Post Scanned EOBs
- Download EOBs from EFTs from the Portals Daily
- Post all payments into Practice Management Software
- Make all necessary adjustments as per guidelines of your office
- Reconcile the postings with Practice Management Reports and adjustments reports ensuring no mistakes in postings and adjustments
- Goal is to post all payments and adjustments accurately.
- Follow-up all outstanding claims
- Resubmit all claims; those did not make it to insurance company first time
- Collect all EOBs
- Collect all cashed checks info
- Appeals if necessary
- Goal is to bring 60+ and 90+ AR balance close to $0.
We support all Practice Management Software including Dentrix, Eaglesoft, Open Dental, Easy Dental, Soft Dent etc. Even if we never worked on your software before, its just the matter of a couple of days to get up to speed. Just let us know what software you have. We will take care of it.
Yes, we do work with any type of Imaging Software Dexis, Vixvin, Schick, XDR or any other imaging software
No problem. We can help you. We will guide you on how to setup everything for us to be able to provide the services to you. We will also guide you on how to convert to digital with minimal expense (just as a courtesy). Regardless, we can support you with no problem. Please call us for further details.
All you need is a scanner and a dedicated computer for our support work.
No, we do not charge a start-up fee. No Commitment. If you are happy with our service, continue. If not you can stop the service anytime.
Absolutely not! There is no commitment. Anytime you see our service is not a value addition, just let us know and you can stop the service anytime. Our goal is to be good part of your business and help making your work easy with reliability. If that’s not happening there is no point in continuing the services.
Capline Services complies with all HIPPA Regulations. We will address all relevant agreements ensuring both parties are 100% compliance with HIPAA/HITECH Laws.
Internet service is required for us to efficiently process and operate Billing Services for your office.
We can go live in the next 2 days itself if you sign-up today, and the remote set-up is done without missing time.
No, we won’t be able to work without setting up a remote access as we need to check your inventory in order to work on your Accounts Receivable.
Claims are submitted in 24 hours of seeing the patient and posted within 24 hours of getting the payment confirmation.
Follow-Ups on your claims are done every week but results may depend on how the insurance processes the claims.
We usually do End to End billing but depending on your billing, we may be able to do just one part as well.
It depends on as much as your work requires to be done within set TATs.
Well, it depends on how much work is there. We would review your daily and monthly work volumes and suggest as suitable. Even if only one system is available, we can manage to work properly.
Usually the system we utilize has to be left idle and staff cannot work on it. But if you have a system with good configuration, we could install a Virtual Machine which can allow simultaneous usage as well.
We will need a signed agreement, a remote system set-up, and a welcome call. Which should take about 2-3 days, if done without missing time.