seven tips and tricks to win insurance in dental

7 steps to supercharge your dental insurance management

Dental insurance management and filing claims are two of the most crucial workflows in a dental practice. Taken one step further, claims management is an essential element in patient and financial workflow and ensures both client satisfaction and organizational health.

Being a task that decides when a patient’s payment is completed and in extension, the revenue cycle of the organization, it goes without saying that dental insurance and claims management workflow must be smooth, bug-free and efficient. Workflows may vary with how your dental practice is set up, but here we will look at a couple of ways in which you can improve how insurances and claims are managed and thus boost effective practice performance.

1. Collecting patient details and verifying eligibility before the patient comes in.

Getting your facts in order and in place beforehand is always an efficiency booster. Use forms and questionnaires to collect as much information about the patient as possible while he/she is making an appointment.

The insurance data thus collected can be verified by contacting the dental insurance carrier. This will ensure that when the patient comes in for the treatment, you will be ready to split the costs and move on to filing claims without a hitch, undoubtedly reducing the time spent on paperwork and focussing better on patient care at the dental practice.

2. Confirming the details with the patient on arrival.

Assuming that, all the dental insurance data collection and verification were done beforehand, it will be very helpful to re-confirm the details with the patient just before the treatment. It is possible that the specifics of the patient or the insurance she holds have changed since the last contact. Don’t let the omission creep in, just confirm again in person. It is important to ensure the patient’s insurance particulars stay up-to-date and valid to ensure a smooth insurance workflow from the enterprise end.

3. Submitting the claims without errors or omissions.

There is nothing more satisfying than getting things done right in the first try itself. Mistakes in claims processing can be very expensive, both for the practice and the patient. It could also weigh down an organization with unwanted and monotonous workload. Getting a claim properly filed without any issues the first time is a win and increases the ‘clean claim rate’! Here are some things which may go about unnoticed.

  • Omission of important procedure codes and license numbers.
  • Usage of deleted or expired procedure codes.
  • Typos in names, addresses, NPI, SSD etc.

Also, keep a note of codes and practices which are identified as fraudulent. An example is code bundling, where a multitude of codes are used to describe the treatment when just one is enough. For example, A dentist performs a one-surface occlusal amalgam. He sends in a claim for 09210-Local Anesthesia; 09430-Office Visit; 02140-Amalgam-One Surface; and 03120-Pulp Cap-Indirect, when Code 02140 Amalgam-One Surface is enough.

4. Developing a good rapport with the dental insurance provider.

If your practice contacts the carrier directly via email or calls, it is essential that there should be a good rapport between the carrier representative and your practice. Good communication means better reception of claims and in effect less waiting or complications. Consider referring patients without dental insurance to carriers who are closely connected with your dental practice.

5. Weekly follow-ups and claim revisions.

Claims do take time to be processed and it will help immensely to follow-up on pending claims on a regular basis, preferably on a weekly basis. This will also boost your rapport with the carrier. Also, tracking claims those are rejected will give you some insight into preventing future rejections.

6. Staying up-to-date on industry standards.

Staying up-to-date with changes in codes, procedures, claim details, carrier plans, etc. is crucial, for both time management and avoiding complications. Consider adding a session to discuss and appraise your team of changes and updations as a part of your weekly or bi-weekly meetings.

7. Investing in technological upgradations for ideal dental practice management

Manual processing or even legacy systems that provide piecemeal solutions fall short of guaranteeing the best results in insurance management. This is because optimal dental insurance delivery is not a standalone process but something that starts from the front office and is heavily dependent on the stability and integrity of the system that administers the clinical and backend processes in a dental practice. A lot of practices have software that deals with just one singular practice management requirement. For better dental insurance delivery, practices must consider upgrading themselves into technologically advanced enterprise software that automates processes right from the front office to claims management.