Dental Insurance Verification: 5 Tips for Real-Time Eligibility & Benefits Verification

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Dental Insurance Verification standardizes claim submissions to improve patient flow to a large extent. Understanding insurance eligibility and the active coverage would help the dental practitioners to get paid for the treatment rendered. If the patient fails to receive the authorization and approval from the insurance company, then the dental treatments can result in an unpaid claim or a lengthy denial rectification. 

To keep up pace with the changing industry, you need to verify the eligibility, payment terms, Co-insurance coverage, and deductibles to keep improving your accounts receivable process. This step is highly prone to errors and can lead to inconsistencies between the treatment and your explanation to the patients why the out-of-the-pocket expense is not estimated correctly.

The problem is tangible as this happens with nearly 75% of submitted claims, it also affects your RCM if not done right the first time. In this article, we discuss the process of dental insurance verification that will help you improve the RCM and avoid recoupment requests. 

1) Get Patient Insurance Details:

Dental offices should ask the right set of questions to understand all the intricacies of the policies; like, “Has your dental insurance plan changed from last time?”, “Have there been any employment updates for the payer?” 

Even trivial mistakes in dental insurance verification can lead to claim rejections. It is not a simple eligibility check. Thus, it is essential that dental offices verify recall/ new patient information benefits through insurance policy details, phone calls with the insurer, or a real-time eligibility system beforehand to expedite the dental billing process. 

Knowing the verified information can help dental practitioners in avoiding any financial and administrative errors. Furthermore, it is best to have a template so that no preliminary information regarding coverage is amiss. 

The following is a checklist to gather accurate and updated information to avoid the risk of out-of-date, incomplete, and inaccurate information verifying the payers benefit:

  • Name, phone number & address
  • Insurance ID/ Group number
  • Name of insured & relationship to the patient, in case he/she is not the patient
  • Effective and end coverage date of the policy
  • Referral or pre-authorization
  • Patient copay & deductible
  • Out-of-pocket expense
  • Benefit limits
  • Diagnosis and services included in the insurance
  • Exclusions of the policy

Dental insurance verification demands pre-authorization even before dental appointments to avoid high insurance reimbursement turnaround time. Therefore, the person handling all this information should follow the standardized rule approved by the government before the claim is submitted to take care of the inaccuracies.

2) Contact Dental Insurance Companies:

A dental practitioner aims for high accounts receivables, and to do so, provide the proper narrative to staff to handle finances vigilantly. The claims get rejected due to insufficient documentation, inadequate policy awareness, or some periodic changes in the insurance coverage policies. Once the information has been fetched from the form, contact the insurance company directly to ensure eligibility, current benefits, and insurance coverage, which eventually helps in treatment schedules. 

Reaching to the insurance companies over the phone can be time-consuming. To make the verification process quick and efficient, clinics should use the procedure codes and other necessary details on the recall/ new patient into your software. In this way, the staff could verify the insurance & benefits more quickly. Additionally, dental practitioners can manage successful dental insurance billing with a clean claim and low-turnaround time. 

3) Follow up and Verify the details:

Usually, a lot of time is wasted in gathering inaccurate data, and a shocking number of practitioners do not check insurance benefits coverage before the treatment. Such scenarios create disagreements and disputes, which can further hinder the verification process. Therefore, it is imperative to conduct a clinical review that confirms that the information shared by the patient is up-to-date and accurate. It is also a good idea to affirm the up-to-date benefits, with the high rates of unemployment, to avoid any such complications. 

4) Examine every detail to support the process:

It is not uncommon for a dental clinic’s employees to make mistakes that later hold funds from future payments. Hence validating it with records save time but also money, based on the content of the claim. A flourishing dental practice relies on satisfied patients without being bogged down by insurance details. 

5) Educating the patients proactively:

Dental insurance verification can affect a dentist’s relationship with their patients. To keep the revenue running as well as providing the best treatment, dental practitioners should communicate with the patient as and when needed. It is better to inform the patient about eligibility, copays, out-of-pocket expenses, and other issues before the treatment begins. Consequently, dental practitioners not only increase their chances of collecting funds as well as patients trust them for their oral health.

Let us be your advocate:

Outsourcing the dental insurance verification process can make a considerable difference in the effectiveness of revenue cycle management. In brief, it is the dentist’s responsibility to provide rendered treatment. This process takes a lot of time, and you have to keep up with new terminology and codes for reimbursements to flow into your account. We, at Capline Dental Services, can help you reduce rejection rates by smoothly managing the process, saving your practice time and money without losing focus from your patients.