Dental insurance claims can be demanding for dentists given the strict rules and intricate processes. Having a sizable number of patients in the clinic might look promising, however, if the payment collections are not keeping up with the service rendered, it can lead to inconsistent cash flow.
Therefore, it is mandatory to follow proactive steps to get paid quickly for dental insurance claims. Unlike any other business, insurance is a way to make money. This means that the collection of dental insurance claims can become difficult.
With that in mind, here is a comprehensive guide by Capline Dental Services exploring the requisites of dental insurance claims and concerns like supporting documentation, dental insurance coverage, authorization, and more.
Track eligibility and dental insurance coverage details ahead of time
Before a patient comes into the dental office, it is crucial to take time to confirm their eligibility and benefits. This step might be time-consuming, but it ensures that the patient has all the necessary dental insurance coverage to pay for their treatment.
It is advisable to check their service history, any divisions for rudimentary or preventive services, waiting periods, frequency limitations, and missing tooth clauses. Doing so can help avoid any confusion or complications down the line.
This information helps dental offices to collect what the patient is financially responsible for upfront. It’s crucial to possess specific details to ensure eligibility. These details include the Payer ID for insurance, the maximum limit of the plan and its usage, the amount of the deductible utilized, the mailing address to file claims, the plan’s effective date, and the relationship to the subscriber.
Submitting the Dental Insurance Claims
The successful processing of a dental insurance claim hinges on the accuracy and completeness of the claim form, comprising 58 individual fields. These details get automatically populated by the practice management software (PMS) and must be up-to-date to ensure timely payment. The PMS captures critical information in four key areas: insurance details, patient details, coding, and billing details.
By adhering to these guidelines, dental offices can maximize their chances of receiving timely reimbursement from insurance providers.
Dental insurance claims processing
After submitting a claim, three common scenarios may occur –
If the insurer requires additional information from the patient, such as evidence of employment or a copy of the divorce decree, the dental office should contact the patient. It is important to note that the patient is responsible for their insurance and claims.