What does dental eligibility verification mean?

How to avoid rejection of dental insurance claims?
How to avoid rejection of dental insurance claims?
February 1, 2023
What happens if an insurance claim gets denied?
What happens if an insurance claim gets denied?
February 3, 2023
What does dental eligibility verification mean?

We all consider getting dental insurance at some point in our lives, but before applying, it is essential to know if we are eligible for it or not. Be it a patient or a dentist; you must know what is involved as a part of dental eligibility verification. It will help enable excellent transparency and build trust between a dentist and a patient.

Dental eligibility verification is the process of verifying a patient’s insurance eligibility for various dental insurance benefits, active coverages, and prior authorization of procedures ranging from dental cleanings to various surgeries. A patient’s insurance plan consists of four essential components:

  • Deductibles
  • Coinsurance
  • Copays
  • Maximum out-of-pocket (MOOP) expenses

There is no way to know how frequently the insurance will pay for the patient’s prophy. For example, you won’t be able to know if a patient is eligible for x-rays or if there is a deductible that applies to the patient’s first visit to your office without verifying the insurance coverage.

Before scheduling an appointment with a patient, an insurance verification specialist at your dental office should contact the patient’s insurance provider to verify that they are eligible to receive dental care under their plan.

It’s possible that the insurance company uses an Interactive Voice Response (IVR) system, which the representative from your dental billing department can use to navigate and verify patient eligibility.

What are the advantages of conducting dental eligibility verification?

Dental eligibility verification is an integral part of the growth of any dental practice. Here are some reasons why every dental clinic should invest in it:

  1. Performing dental eligibility verification allows dentists to know what exactly is covered under a patient’s dental insurance plan and what’s not before providing any treatment. Accordingly, they can submit accurate dental claims to a dental insurance company. This will help them reduce their claims denial rate and increase revenue eventually. 
  2. It also helps educate the patients about all the benefits they can claim under their insurance plan so they can make an informed decision.
  3. The dentist-patient bond gets strengthened as the patient develops a sense of trust. And as we all know, trust is the first step towards making a patient visit the same dentist again.

How is the verification done at a dentist’s clinic?

Dental insurance verification services can help in automating the process of dental verification at your dental practice. It will also help integrate new insurance information into the software used for patient management.

Dental insurance verification services are generally compatible with the dental practice software that dentists use, regardless of whether your dental practice focuses on cosmetic dentistry, orthodontics, restorative dentistry, or family dental services.

This becomes more relevant when you outsource the verification of dental insurance to an insurance verification service provider or an automated system. With this, you can fully focus on your patients without worrying about the verification procedures!

When you outsource the process of dental insurance verification to a built-in dental billing service, your dental practice will save hours of labor and see an increase in the number of claims that are approved. You need to find a reliable dental insurance verification service so that your billing professionals can be relieved of the responsibility of performing automated insurance verification.

What are the consequences of not conducting dental eligibility verification?

There can be several consequences if dental eligibility verification is not done, as because of it, patients will not be able to claim their insurance benefits. And as a result, your dental practice may end up with too many write-offs, unhappy patients with unexpected balances, poor online reviews, fewer patient referrals, and so on. To cut a long story short, verifying dental insurance improves both the revenue and the overall patient experience.

What services do companies specializing in dental insurance verification provide?

Even though several different systems can help your office’s patient eligibility verification process become more streamlined in the dental billing department, automated benefit verification will never be able to completely replace the need for an insurance verification specialist. Your verification processes can be outsourced to dental insurance verification companies. This will help in effortlessly conducting the process.