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Front Office Systems

Dental Insurance Verification

Before providing dental care, it is imperative to confirm how a patient will pay for your services. In many cases, patients will expect you to file a claim on their behalf through a dental insurance plan. Verifying insurance eligibility will reduce collection challenges but add to the workload for the front office team.

 

There are several ways to verify insurance eligibility; via fax, insurance company webpages, using a third party such as eCentral, or by phone to an insurance company representative. In some practices, there is adequate front office staff for a thorough eligibility verification process. In others, the return on investment for a thorough process does not balance the time investment. There are two different insurance verification models to choose from; you will need to pick the best model for your practice.

 

 

1. A Thorough and Complete Benefits Verification Process

 

This verification form can assist you with a thorough and complete verification process. You will need to collect the patient’s full benefits and enter the data into your practice management software. This will create the most accurate treatment plan to reflect the patient’s financial responsibility. When using this system, we encourage your team to collect insurance information and verify all benefits and eligibility before the patient comes in for their appointment. You will need to gather the following information:

  • Patient’s name and date of birth
  • Name of the primary insured
  • Social security number of primary insured
  • Insurance carrier
  • ID number
  • Group number
  • Contact information for the insurance company; including phone number, website, and address for submitting claims

While we recognize this process to be the most accurate, it is the most time-consuming. We also realize phone verification through an insurance representative can result in incorrect information. Be prepared to use good verbal skills when explaining estimates provided, rely on the information you have received, but understand it is not a guarantee of payment. Ultimately, the patient is financially responsible for the care provided.

Request an editable version of the Thorough Verification Form from Practice Support Team.

 

 

2. A Simplified, Shorter Eligibility Verification

 

You may choose a simplified approach to the insurance verification process by eliminating (or reducing) the need for phone calls with insurance representatives. You will utilize information gathered from insurance company websites and faxes to create estimates.

In this scenario, you are using general estimating guidelines without the time investment of the thorough and complete benefits verification process. You will enter eligibility data into your practice management software to create estimates. We recommend you estimate high to reduce the possibility of conflict when the patient balance is higher than expected. With a simplified version of the benefits form, your front office team members will need to clearly explain the estimates on the treatment plan are ONLY estimates; any amount not paid by the insurance company will be the patient’s responsibility. This approach is less time-consuming while providing a ballpark estimate for the patient.

We recommend you pre-determine benefits for larger cases when using this simplified, shorter eligibility verification process.

Request an editable version of the Short Verification Form from Practice Support Team.

 

 

Organized procedures for collecting patient information and verifying insurance eligibility will help facilitate streamlined claims and billing processes. With either method, you must educate your patients on the limitation of dental insurance and stress your desire to provide the care they need while helping them navigate the insurance process. The Practice Support Team is available to help you set up a verification process and protocol that works for your practice.

 

 


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