Many dental insurance claim denials commence from the initial steps of the revenue cycle. It is thus imperative that a dental practice pays strong heed to dental insurance verification right at the start of the patient journey.
A practice can verify the insurance coverage of a patient using automated verification software as it raises the probability of getting claims approved the first time and safeguarding revenues. Prioritizing insurance eligibility can also ensure a better patient-practice relationship.
A patient can get frustrated in case insurance claims are denied as they also need to manage out-of-pocket expenses. Dental insurance verification helps lower claims and offers a patient better control over their financial outlays while also enabling the practice to focus on treatment and care.
Insurance verification needs to be accurate and timely for a claim submission to be successful and a denial can impact the patient as well as the practice. A rejected claim affects the patient and the practice.
If a practice can share an accurate estimate for treatment to be rendered, the patient can then be prepared for payment of bills and make payments on time. It also helps increase customer satisfaction by offering a complete patient experience.
Automated pre-service eligibility verification reduces the workload on the dental team while offering a far higher level of accuracy. Outsourcing billing services to specialists can also help reduce the workload on the team while also boosting revenues.
A few ways how accurate verification helps:
A vast number of denials can be prevented if the initial verification is accurately done. Typo errors, incomplete patient data, delays in filing, an expired insurance policy, etc are reasons that can lead to a denial. Paying careful attention at this step can lead to a higher rate of claim submissions.
The team needs to compare the data in the system with the information that is filled in by the patient and corrections if required must be carried out.
An insurance company generally allows a duration of 60 to 90 days for claim filing from the date of treatment rendered. A failure to file claims accurately and on time can lead to a claim denial.
If there is an emergency, the practice must keep the insurance company informed about patient details so that the claim submission process does not get affected.
If a patient has a policy that has expired, there will be no coverage provided and hence the claim will get automatically denied. The dental team needs to confirm if the policy is live and avoid a claim denial thereby making the claim cycle more efficient.
Insurance companies generally have prescribed in-network and out-of-network repayment arrangements. An insurance company can also have restrictions on the coverage depending on the state or region. The team needs to check the insurance policy of the patient and authenticate the eligibility for treatment to prevent claim denial.
Many situations can make a patient change the insurance plan or even the insurance provider. It is thus vital for the dental team to examine the details of the new plan when updating the details of the insurance policy. When a patient updates or changes the insurance plan, the practice must update the all details on their system as well as start the eligibility verification process again to avoid a claim denial.
Due to negligence or a lapse by the dental team, a claim if lost will not make it to the insurance company for processing. Hence a process that monitors and tracks claim preparation and submission must be put in place as this will ensure that all claims are filed and submitted on time.
Some insurance plans might have exclusions that are not covered and this could include a disease or a procedure. Hence the team must check on all inclusions and exclusions to prevent a claim denial.
Dental insurance verification not only curtails inaccuracy in billing but also lowers the possibility of claim rejections due to a lack of information, errors in submission, or inadequate insurance coverage. The practice can automate the eligibility process or outsource the function to a specialist to ensure negligible claim denials and faster accrual of revenue.
