Dental Insurance Verification Checklist

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According to statistics millions of dental claims have been denied because a patient was not eligible for the treatment already meted out to him/her by the healthcare provider. This usually occurs when the process of dental insurance verification is carried out in an inadequate manner. Insurance carriers have genuine reasons for not paying the claims submitted to them as they operate with a certain set of rules and regulations. This is why it is very important for anyone who does dental insurance verification to have a dental insurance verification checklist be it in house administrative staff or a team of experts a practice has outsourced this task to.  

When it comes to dental patient eligibility verification the people who do it successfully have the right knowledge about different types of insurance plans, kind of insurance providers as well as the different guidelines they need to follow to ensure proper compliance.The amount of information one needs to crosscheck for each and every insurance verification can sometimes be quite overwhelming which is why it is important to have a checklist in place. A checklist is the perfect reflection of the abilities of a verification specialist as it helps him/her make sure that each and every detail related to the claim is covered in the verification process. 

Here are the essential things that a dental insurance verification checklist should contain: 

  • Type of Plan
  • Fee Schedules
  • If insurance covers the procedure, diagnosis, or services to be provided
  • Required documents 
  • Deductibles and maximums 
  • Missing Tooth Clause 
  • If the coverage is currently active or not
  • Specific codes as per procedure performed 
  • Waiting period if any 
  • Key information like phone number, address, payer ID and fax number 
  • Insurance name, phone number, and claims address
  • Insurance ID and group number
  • Effective date of the policy
  • End date for the policy

In addition to this, the person who is carrying out dental insurance verification should always ask for a copy of new insurance information in order to match with the one stored in the insurance carriers database. After that getting in touch with the insurance provider over call or email should also be taken into account as it helps become 100% sure. Some companies like Capline Dental Services use integrated billing systems that can pull up the same data from electronic records thus making the process of verification easier. We also believe in building personal rapport with patients and are quite honest about any missing deductibles or copays required to get hassle free treatment for our patients and smooth reimbursements for the dental practitioner they have received services from. Our experienced staff has spent quite a few years doing the same and the key to their accuracy and success is their strict adherence to dental insurance verification checklist.