Quick Tips for Dental Insurance Claims Processing

Insurance claims processing is verifying the accuracy and necessity of a submitted claim. This process begins from the moment a patient walks into your practice. It ends once you are reimbursed for 100% of what you’re rightfully owed by the insurance company. Each claim requires dedicated, knowledgeable attention in order to be paid. By knowing the process in and out and what solutions are available to you, your practice can enjoy less stress and long-term success. Let’s grab some quick tips for dental insurance processing 101:

How are dental claims processed?

The dental claims processor is responsible for processing claims that are submitted by dental healthcare providers.

1. Ensure that services provided are covered by the policy
2. Review the claim for accuracy in narrative structure and coding
3. Resolve any issues with rejection or denials

What does a dental claims processor do?

Your dental billing team spends countless hours between claim submission and possible appeal. This means comparing the claim amount to patient policy limits, deductibles, and co-pays, as well as any other factors that may impact the reimbursement amount. Then, the claim is submitted and ideally reimbursed within a short period of time. If the claim is rejected, your team has the responsibility of chasing down reimbursement and figuring out what when went wrong.

• Was the patient’s insurance verified prior the appointment?
• Did we effectively structure our narrative to show treatment necessity?
• Are there coding errors from outdated resources?

The job of your dental billing team is dependent on accuracy from multiple parties, from the front desk to the doctor. Without cohesive, targeted communication, the claims process becomes that much harder, and your reimbursement chances that much lower.

How can we solve this?

• Make templates of frequently used narratives to create a rubric for each treatment
• Create a standard operating procedure for the entire team to be a part of to ensure compliance across the entire office
• Utilize a professional coding resource that doesn’t leave your billing to chance

Consider the possibility that your office may benefit from a dedicated billing platform to support your team in increasing revenue. While doing so, you can focus on the primary needs of your practice: your patients.

Keeping patients satisfied with treatment acceptance

Your dental billing team also has the task of making sure that patients understand what their policy does and doesn’t cover. This directly leads to less likelihood of treatment acceptance as well as a bad taste in the mouth of patients who constantly have surprise copays. Has your dental billing team been set up for success when it comes to this knowledge?

How does dental insurance claims processing work?

Ideally, you should be attempting to increase your collections to 98% or more. Not sure if you’re meeting that goal? Our Revenue Health Assessment gives you a clearer idea of where your practice can meet and exceed your financial goals.

Who processes dental claims?

The insurance company that claims are sent to always has the final say in whether or not you get reimbursed for services provided. All of the work that goes into crafting the perfect claim is meaningless if there’s no necessity for treatment. Did the doctor properly offer a clinical need for each step in treatment? Or is there room for improvement in establishing authority?

Put your claims reimbursement strategy on autopilot

eAssist Dental Solutions provides a dental billing platform customizable to your practice needs. If you’re looking for a trusted partner in dental billing and beyond, eAssist can help. Whether your practice struggles with consistent insurance verification or patient billing, our platform gives you a personalized solution to increase revenue. Our accountability comes from daily reporting as well as an open line of communication for any questions you may have. Tell one of our Business Development Specialists what your financial goals are and let us support you in meeting them. Schedule a chat today by clicking below and partner with the nation’s leading provider of practice management solutions.

Natalie Rogers

Director of Business Development