Dental Insurance Verification Training for Efficient Dental Offices

Dental insurance verification training is a crucial aspect of running an efficient dental office.

In the United States, it's estimated that over 50% of dental patients have dental insurance, making verification a vital step in the patient intake process.

Accurate verification reduces claim denials and ensures timely payment from insurance providers.

According to industry experts, dental offices that implement effective insurance verification protocols can increase their revenue by up to 15%.

Additional reading: Delta Dental Insurance Verification

In this dental insurance verification training, you'll learn the ins and outs of the process.

You'll discover why and how to do insurance verification for patients, which is a crucial step in making sure you get paid.

To avoid wasting your team's time over the phone, you'll learn how to best use a dental insurance verification template file.

You'll also find out the specific details you need to find out to ensure you get paid, which will save you time and headaches in the long run.

Here are the key takeaways you'll learn:

Verifying patients' dental insurance benefits is a crucial step in reducing recoupment situations and ensuring accurate billing.

To verify eligibility, dental offices can use the payer's online portal or call the toll-free number on the patient's identification card. However, this information may not be up-to-date or accurate.

You'll need to document interactions with the payer, including screenshots of the portal or date and time when the customer service representative was contacted. This can help with future dispute resolution.

To make the call to the insurance company, you'll need the subscriber name, date of birth, subscriber ID or Social Security number, and your office's Tax ID.

To verify insurance details, it's essential to regularly update the information in your practice management software, especially before appointments. You can also encourage patients to inform your office of any changes to their insurance plans as soon as they happen.

Here's a list of essential information to collect during the intake process:

Verifying patient benefits is a crucial step in the dental insurance process. It's essential to verify both the patient's insurance and the insurance company's fee schedule to ensure accurate coverage.

Don't assume you're not in-network with an insurance company just because you haven't heard of it before. Get the policyholder information and provider services phone number, and call the insurance company to find out what fee schedule they follow.

Some insurances may not be aware of changes in a patient's employment status, so it's essential to verify eligibility on the date of service. This can be done through the payer's online portal or by calling the toll-free number on the patient's identification card.

You should verify insurance details before appointments, whether manually or using a tool. Regular updates will help reduce miscommunication and improve accuracy. Patient communication is also key, so encourage patients to inform your office of any changes to their insurance plans.

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To verify insurance, you'll need the subscriber name, date of birth, subscriber ID/Social Security number, and your office Tax ID. Make sure to update the insurance information template with the date of the initial call to the patient's insurance, as benefits can change over time.

When verifying orthodontic benefits, find out how the benefits are paid and whether you need to submit a claim. Most insurances don't pay in one lump sum, but rather periodically.

Here are some key points to verify when checking insurance benefits:

By verifying patient benefits and following these guidelines, you can ensure accurate coverage and avoid potential issues down the line.

Crown & Bridge procedures can be complex, and insurance coverage varies widely.

Some insurances will downgrade D2750 to a D2790 or D2792, so it's essential to clarify this with your provider.

Be careful with Core buildups, as many plans are now "bundling" them with Crowns, meaning they won't pay a separate payment for Core buildups.

Aetna, for instance, requires specific documentation, including Pre-op and Post-op photos, X-rays, and a narrative, to even consider payment for a Core buildup.

Insurance plans can also downgrade coverage for all posterior teeth or only the molars, so ensure this is filled out correctly on your claim.

You can significantly reduce administrative time by using this dental insurance verification system. This is especially true when verifying benefits for new patients with insurance.

One way to do this is by timing yourself when calling insurance reps to see how long it takes to go through the file. Tracking your improvement over time can help you refine your process.

By grouping patients with the same insurance plans together, you can make multiple calls at once, saving even more time. This is a great way to make the most of your downtime.

Here are some tips to help you maximize efficiency:

Eligibility Verification is a crucial step in maximizing efficiency in your dental practice. It's essential to verify a patient's eligibility on the date of service to avoid recoupment requests in the future.

Payers can reflect eligibility changes retroactively, and clauses within participating provider contracts allow them to recoup funds from the participating dentist when treating a patient who has lost benefit coverage. Out-of-network dentists are not contractually obligated to return payments received in this situation.

You can verify eligibility through the payer's online portal or by calling the toll-free number on the patient's identification card. However, a patient's dental plan may not have received timely notification from the employer informing the plan that the patient's employment and/or corresponding benefits have been terminated.

To ensure accuracy, document interactions with the payer, including screenshots of the portals with a date-and-time stamp or by recording the date and time when the customer service representative was contacted along with the name of the representative.

Ask patients to provide some information during the visit to screen for potential eligibility changes. Sample questions to ask include:

The dental insurance verification system is comprehensive, but using it for all new patients with insurance can quickly consume a lot of administrative time.

Timing yourself while on the phone with insurance reps can help you track your improvement and identify areas for efficiency gains.

You shouldn't waste time getting implant, oral surgery, or other unnecessary benefits for patients who are only coming in for routine procedures.

Requesting a fax breakdown of benefits while on the phone can help you fill in details and make the process more efficient.

It's not always possible to verify benefits before the patient arrives, so it's essential to have a system in place for verifying eligibility during the appointment.

Grouping patients with the same insurance plans can help you make multiple calls at once and save time.

You'll need to develop your own process that works for your office, but the template is meant to organize information and can be customized to fit your needs.

Here are some tips for maximizing time efficiency with this system:

Incorrect or incomplete data in your PMS is a common issue, and it's easy to see why: you or your team might enter the wrong information, or patients might not complete their intake forms. This can lead to issues when verifying insurance.

Collecting insurance and personal information during intake can help improve this situation. Online forms are a great way to collect this information, as they reduce keying errors and allow you to sync the forms to your PMS.

Another challenge is verifying patients' dental insurance benefits, which is crucial for scheduling appointments and determining treatment costs.

Incorrect or Incomplete Data in PMS is a common issue that can lead to problems verifying insurance and getting a complete picture of patient profiles.

Entering incorrect information into a Practice Management System (PMS) is inevitable, even with careful keying. This can happen when you and your team manually input patient information.

Collecting insurance and personal information during the intake process can help reduce errors. Online forms are a great way to collect this information, as they eliminate the need to decipher different handwriting styles.

Using online forms also allows you to sync them with your PMS, reducing keying errors and overlooking critical patient information.

Overlooking changes in patient plans can lead to miscommunication and inaccurate insurance verification. This can happen when patients switch jobs, get laid off, or experience other changes in their insurance plans.

It's essential to have a routine of verifying insurance details, especially before appointments. This can be done manually or using a tool to ensure accuracy.

Encourage patients to inform your office of any changes to their insurance plans as soon as they happen. You can include signage at your front desk, include a short video clip on your smart TV, include it on your insurance page on your website, and even train your clinical team to ask during chairside conversations related to treatment planning.

Collect current copies of their insurance cards (front and back) and/or insurance details in your PMS and patient engagement system during the intake process. This will help you stay up-to-date and avoid any miscommunication.

Here are some key questions to ask patients during the visit to screen for potential eligibility changes:

By following these steps, you can ensure that you're always up-to-date on your patients' insurance plans and avoid any potential issues with insurance verification.

Verifying insurance in advance can save you from scrambling to do it on the day of the appointment, which can lead to potential errors. A good rule of thumb is to verify a patient's insurance up to 3-4 days ahead of their appointment.

You should also get the history of preventive services for family members under the same plan. This includes getting the history of dates of service for last examinations they had.

For plans that allow exam frequencies of 2 every 12 consecutive months, be careful in giving a new patient an appointment for an initial exam or a recall appointment to an existing patient. This can result in a denial of payment for services rendered.

Here's an example of how this can play out:

In this scenario, the new patient is not eligible to receive a benefit for an examination until 5/15/2015. Make sure to get this information before scheduling an appointment.

You should also get the history of last placement of sealants, even if coverage is listed at 100%. This can help you avoid surprise out-of-pocket expenses for patients.

It's crucial to get the history of preventive services for family members under the same plan when verifying insurance for a new patient. This ensures you don't inadvertently schedule appointments that aren't covered by the insurance plan.

You should also get the history of date of service for the last examination and be mindful of exam frequencies, such as plans that allow two exams every 12 consecutive months. This will help you avoid scheduling appointments that aren't covered by the plan.

Regular updates are key to maintaining accurate insurance information. This can be done by verifying insurance details before appointments, encouraging patients to inform your office of any changes to their insurance plans, and having current copies of their insurance cards on file.

To avoid financial surprises, make sure to inform patients of their out-of-pocket responsibility before the appointment, especially if they're not eligible for benefits due to exam frequency limitations.

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Building trust with your patients is crucial for a successful practice. An angry patient is far less likely to pay because they feel betrayed and tricked.

Verifying a patient's insurance up front can significantly reduce issues in your practice. This is exactly what eAssist's insurance verification service does.

Clear communication is key to establishing trust with patients. An honest and transparent approach will help you build strong relationships with your patients.

By taking care of insurance verification upfront, you can avoid last-minute surprises and keep your patients happy. This is a simple yet effective way to build trust in your practice.

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Verifying orthodontic benefits can be a challenge, and it's essential to understand how they are paid. Most insurances don't pay in one lump sum, so you'll need to submit a claim.

You'll want to find out if the insurance will pay automatically, and if so, how frequently the payments will be made. This will help you plan and manage the process more efficiently.

Most insurance representatives will tell you that benefits are paid automatically periodically, so be sure to ask about the payment schedule.

Expand your knowledge: Benefits of Dental Insurance