Tuesday, June 28, 2022

How To Process Dental Insurance Claims

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Get Authorization For Extended Health Care Claims If Necessary

How to Fill Out A Dental Insurance Claim Form & Post Payments & Adjustments

Your attending physician must authorize services from a Psychologist or Speech Pathologist/Therapist before we can consider your claim.

For all extended health care services, we only pay claims after you have reached the annual maximum in your government health insurance plan. Your medical practitioner must include documentation stating the date you reached that annual maximum. Any costs within the eligible per-visit government health insurance plan allowance are not covered and are your responsibility. Please refer to your Schedule of Benefits for your coverage details.

Always Review Your Eobs And Provider Bills As Errors Can Happen

As weve discussed, its always a good idea to thoroughly review your Explanation of Benefits and provider bills to make sure everything is correct. Hopefully these tips for reviewing dental claims, EOBs, and provider bills can help make sure youre getting the most out of your dental benefits. If theres a discrepancy, then its always good to discuss these with your dental provider. With some knowledge and a little negotiation, you can be sure to pay the correct amounts for your dental services or even less.

Find PPO dental plans to see any dentist

Electronic Or Paper Claims

Due to the fact that many dental claims require attachments such as radio-graphs and periodontal charts to prove medical necessity, over half of all dental claims are sent as paper claims in the mail.

Although some dental insurance practice management programs do offer the option to scan and attach the necessary medical documents, they also come with a higher price tag.

Not only is this type of software more expensive to buy and maintain, but it’s more expensive to send these types of claims electronically than regular medical claims, for example.

To determine whether or not it’s in your best interest to buy this type of software and send electronic claims, you need to determine what’s more cost effective:

  • the added expense but greater ease of sending claims electronically
  • or the postage and time required to send paper claims.

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Get An Estimate For Prosthetic Appliances Durable Medical Equipment And Hearing Aids

Before you arrange for any of these, ask for a cost estimate and send it to us. We will let you know how much we will pay. Keep in mind that most government health insurance plans also contribute towards these costs.

When you submit your claim, you must include:

  • Original receipt
  • Copy of government health insurance plan contribution statement

Q: You Told Me I Owed One Amount But Now I Have A Bill For More I Thought My Insurance Company Was Supposed To Cover This What Happened

Outsource Insurance Claim Processing Service

A: We do our best to estimate your out-of-pocket cost before you leave our office. Its always our goal to be as accurate as possible about what you owe for your visit. As much as we try to be experts on every persons dental insurance, our real expertise is in dentistry! Please remember that we are a PPO for many insurance companies and each company has dozens of plans that an employer can purchase for an employee. We encourage all patients to be advocates of their own health. But rest assured that we will do everything in our power to make sure you get the full benefit owed to you by your insurance company.

Here are a few reasons why you may have received a bill:

  • Your insurance plan paid a lower percentage than expected for the procedure.

  • The treatment you needed was not covered by your plan.

  • The insurance company decided you did not need a procedure that the doctor identified as necessary or downgraded a procedure code.

  • You have not met your deductible.

  • You have not reached the end of your plans waiting period and are ineligible for coverage.

  • Youve maxed out your plan and no longer have coverage until the plan resets next benefit period.

But insurance can be really confusing. Thats where we come in. We will take the time to explain your benefits to you as best we can. Its why we have so much information on our website. We want to educate you so that you can be empowered to take charge of your health and get the full benefit of your insurance.

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Make Sure Your Dental Claim Has Been Filed With The Insurance Carrier

If you have a dental plan, the first step is for a claim to be filed with the insurance company. In most cases, the dental office will file claims to the insurance company. In Network dentists are required to file dental claims, but many Out of Network dentists will also file claims as a courtesy to their patients.

Once the claim has been received and processed, the insurance company sends an Explanation of Benefits or EOB to the member and a remittance statement with any payment due to the providers office. Normally, dental offices will then send a bill to the member for any outstanding charges that were not covered in full by the dental plan.

However this is where some confusion can enter the process. Now well explain how to review your EOBs and provider bills with a few things to look for.

Dental Insurance Claims Processing 101

Dental claims processing entails all aspects of giving care to patients, starting from the moment a patient is registered until the explanation of benefits and payments are completed. Dental insurance claims are submitted via paper and electronically.

Electronic transactions are where clearinghouses such as the Smart Data Stream Clearinghouse come in.

Clearinghouses give dental practices the tools and access necessary to submit, receive and request information from different payers. A quality clearinghouse is one that successfully provides a seamless data exchange between dental care providers and insurance payers.

Dental claims are complex, but understanding the workflow can help businesses identify areas to reduce cost and speed up turnaround time.

    Steps in Dental Insurance Claims Processing

    The first step in the dental claims process is to ensure that the patient has been seen and received care. After a patient has visited a dental provider, claims go through several steps before patients receive their final bill:

  • Billing. Insurance is sent a bill for charges of service, not including any charges paid via co-pay upon check-in.
  • Adjudication. A certified claims processor will review the claim, ensuring accuracy and comparing it against the insurance plan to validate that services rendered were or were not covered by insurance.
  • Final Billing. A final bill will be sent to the patient for payment, if applicable.
  • What is a Dental Insurance Claims Clearinghouse?

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    Q: The Dentist Says I Need A Certain Procedure But It Isnt Covered By My Insurance Why Not Isnt There Some Other Procedure That Would Work Just The Same

    A: Our doctors diagnose and provide treatment based on what you need, not based on what your insurance covers. Some employers or insurance plans exclude coverage for necessary treatment to reduce their cost. If youre having trouble affording your dental care, ask us! We offer financing options and if the procedure allows, we can sometimes spread out treatment a little to help you afford it.

    Your Plan And The Claims Submission Process

    Dentrix-Integrated Insurance Claims Processing with eClaims

    Once your dental appointment is over, its time to make your payment and submit your claim. The way you submit your claim and get reimbursed depends on:

    • whether the dentist submits it for you
    • whether you assign your benefits to the dentist
    • or have the plan pay you directly.

    Some dentists accept the assignment of benefits. The assignment of benefits means your insurer pays your dentist directly. The dental claim can be submitted to the insurance company by the dental office. All you need to do is provide the dental office staff with your benefit plan number and/or benefits card. Any fees that are not covered by your plan must be paid by you to the dentist.

    There are some dentists who do not accept the assignment of benefits there are some dental plans that will not allow benefits to be assigned. This means that the plan member will be paid by the insurance company. In both cases, this means youll need to pay your dental bill upfront. The dental office can still submit the claim electronically to your insurance provider on your behalf and then you wait to get reimbursed.

    Getting reimbursed is much faster than it was years ago. Thanks to electronic claims submission, you can see the dentist on Monday and usually get reimbursement before the end of the week. Also, many dentists accept credit cards, which typically have a monthly billing cycle. If you need complex treatment, speak to your dentist about arranging a payment schedule that allows you to budget for expenses.

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    Myth #: Once I Batch A Claim It Will Be Submitted

    Batched claims are essentially dental claims that are in line to be sent to the insurance company. Just because a claim has been batched doesnt mean it has been sent to insurance to be paid. A big reason people believe a batched claim is a sent claim is simply because they havent been told otherwise.

    Verify Eligibility Ahead Of Time

    The first step to process dental insurance claims more quickly is to verify eligibility ahead of time. Get that done before the patient comes into the office and youll reduce paperwork and billing headaches. With the Vyne Trellis platform, theres no need to sit on the phone verification can be done electronically to save even more time.

    Our secure paperless solutions* also make it easy to request updates from patients before their appointments via SMS or email.

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    With The Growing Trend Of Dental Industry Consolidation The Time To Automate Your Billing Is Now

    The dental industry is consolidating into larger practices resulting in:

    More complex billing operations

    The need for sophisticated RCM analytics

    Unprecedented pressures for RCM scaling

    In fact it is estimated that dental providers leave $2.1 billion on the table due to poor billing practices and a slower-than-average adoption of automated tech solutions. Loss of revenue is even greater for emerging DSOs that are considering taking on more dental practices and consolidating their organization.

    We make sure your practice doesnât fall into this statistic.

    Q: I Have Insurance So Why Is There An Out

    Provider Services

    A: Dental insurance generally offsets the cost of treatment, but doesnt pay for it entirely. On average, dental insurance covers 80-100% of preventive , up to 80% of basic and up to 50% of major . We do our best to estimate your portion of the payment before you leave our office, but with literally dozens of insurance companies and thousands of individual plans its simply impossible for us to know all of them. Thats why its so important for you to know your plan and take charge of your health!

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    Where Do Dental Claims Processors Work

    A dental claims processor works in a dentist’s office or other healthcare facilities that offer dental care. Because this job does not require meeting patients or dental staff face-to-face, you may be able to work remotely and handle claims processing needs for one or more dental offices. Regardless of where you work, you need office equipment such as a computer and phone. Dental claims processors are in frequent contact with insurance providers, so you need a reliable phone connection or mobile service.

    Include All Relevant Information

    Dental insurance companies frequently require additional documentation to validate insurance claims. This can include anything from X-Rays to charts to narratives explaining why patients need a given treatment. Including everything the insurance company is likely to ask for in the submission of the initial claim reduces the amount of back-and-forth and speeds up payment.

    Its important to note that dental insurance companies may delay or deny coverage if X-Rays and other information are the wrong size or submitted in the wrong format.

    Vyne Dentals FastAttach solution makes it simple to send all necessary attachments electronically safely and securely.

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    How To Submit A Claim Electronically

    Use Provider Tools for free real-time claims with digital attachments and pre-treatment estimates. Youll see Delta Dentals payment and the patient portion when the claim or pre-treatment estimate processes, often within moments .

    First, log in to Provider Tools. From there, you can transmit claims, digitized attachments and pre-treatment estimates with either of these tools:

    • Submit Claim: transmission is quick and efficient.
    • My Patients: your current patients are listed here and we add new patients as their claims are processed. Patient information is automatically entered on your pre-treatment estimate or claim.

    You can also use FastAttach®, a service available through National Electronic Attachment, Inc. , to electronically transmit digitized x-rays, periodontal charts, Explanation of Benefits documents, photos and narratives.

    If you are not submitting claims electronically, talk with your practice management system vendor about activating your systems electronic claims component.

    Avoiding Late Claims Submissions

    Open Dental Webinar- Claim Payments

    When you submit claims as soon as possible after treatment is completed, you help us process claims more efficiently, using the patients most current eligibility and benefits to determine payment.

    Generally, claims received more than 12 months after the date of treatment may not be paid. However, some programs may require you to submit claims within a shorter period of time . To be sure, please refer to your dentist handbook. If you receive notification that no payment was made because of late submission:

    • The patient is responsible for their coinsurance/copayment portion only. The amount that would have been payable by Delta Dental may not be charged to the patient.
    • If late submission occurred because of extenuating circumstances , you may request reevaluation of the decision to disallow payment. Please call or write to our Contact Center .

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    Insurance Claims To Process Report

    The Insurance Claims to Process Report includes all insurance claims that have been created in the Ledger but not sent to the Batch Processor, printed, or sent through eClaims. This report includes the range of patients, providers, and carriers you specify. The report also includes the claim date, type of claim , patient name, insurance company name, claim amount, and expiration date. Additionally, a total of the amounts for Primary Claims and Secondary Claims and a combined total print at the end of the report.

    To generate the report

    1. In the Office Manager, click Reports, point to Ledger, and then click Insurance Claims to Process.

    The Insurance Claims to Process Report dialog box appears.

    2. SelectDental to include dental insurance carriers or Medical to include medical insurance carriers.

    3. Type the Report Date that you want to print on the report. The default is the current date.

    4. Do the following:

    · Select Patient – Select the range of patients that you want to include. Click the From and To search buttons to select the starting and ending patient, respectively, or leave < ALL> selected in both fields to include all patients.

    · Select Primary Provider – Select the range of primary providers that you want to include. Click the From and To search buttons to select the starting and ending providers, respectively, or, leave < ALL> selected in both fields to include all primary providers.

    5. Click OK to generate the report and send it to the Batch Processor.

    Electronic Solutions For Easy Claim Submission

    Want to get paid faster? Submit your claims electronically! You should:

    Review the Electronic Claim Vendor List Electronic Claim Vendor ListYou can also submit paper claims. Claim FAQ

    While we encourage you to submit all claims electronically, if you need to submit a paper claim, Review our paper claim Tips

    Submit your attachments, such as X-rays, electronically using FastAttach® by National Electronic Attachment .

    Our guidelines explain when we require attachments.

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    Call For Help If You Need It

    Nobody likes calling insurance companies, but its often the fastest way to get claims issues resolved. Dental insurance companies frequently have representatives available to answer questions regarding eligibility and claims during business hours. If youre having trouble getting your claims processed correctly, call for assistance.

    If youre using Vyne Dental, our support team is also here to help whenever you get stuck.

    To The Dental Billing Process

    Periodontal Dental Insurance Claims

    Every dental office should follow some form of a dental billing process.

    It doesnt matter if you are a startup office or an established clinic. Its a simple fact that many dental offices across the U.S. struggle with this process. You may have just stepped into this new world of dental billing, and not know up from down. We get it. It can be complicated and super detailed.

    If one part of the process is broken, it can seriously affect your collections. The dental billing process is performed best as a team effort, composed of various administrative employees. Working together will ensure there are no kinks in the chain.

    Our company, Dental ClaimSupport , was founded on the principle that not all dental offices have a streamlined dental billing process. A couple of the founders of DCS actually worked with a small group dental practice composed of 8 offices and realized that all eight offices did their billing differently, even though they were part of the same umbrella.

    We wondered: Why does everyone do this process differently? Then we thought if everyone here handled billing differently, surely other offices across the United States were. We were right.

    If you want a Free Dental Billing Assessment for your office, you can get assessed here.

    You will not be shortchanged in this article. Get ready for a full breakdown of the entire dental billing process. This will be your ultimate guide to the dental billing process and getting claims paid!

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    Are You Diligent About Insurance Verification

    After you obtain this information, you need to confirm the patients coverage is currently active, what procedures are and are not covered, and the percentage of the costs covered for procedures. This is called insurance verification and needs to be a regular step in your billing process.

    This can be done in your insurance verification software, or you can call the insurance company yourself to verify all of this information.

    If your team enters all of the patients information into your dental software accurately and verifies the patients benefits, there should be no problem in sending an accurate claim that will be paid by insurance promptly.

    You will also know how much you can expect to receive from the insurance payer. If you know this amount, that means youll also know your patients out-of-pocket expenses, which should be collected before they leave the office after their procedure.

    Making sure all of the insurance information is accurate is key is getting insurance claims paid.

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