Auto-Adjudication is King

Auto-Adjudication Has Arrived

Dental insurance companies have been using technology that 1) saves them money and 2) gets claims paid faster.  We certainly already know insurance companies save money anywhere they can, but getting claims paid faster needs to have our attention!  Auto-Adjudication is now King in the dental world and will continue to be for a while. It’s time dentists and office managers really know what this means and how it can be used to benefit their practice!

Humans to Automation

Auto-Adjudication is the process in which insurance companies have a computer processing claims for them instead of a human being.

Obviously, this is cheaper than paying human beings, right? Of course, and we all know this is going on behind the scenes of a dental insurance (or at least we should know by now).  But how does a dental office take advantage of this? How does this help us get your claims paid faster, you may ask?

We WANT to have our claims go through the auto-adjudication process to get paid claims FAST!

 Your office only survives if you collect what you are producing.  If you are not getting preventative and basic claims paid with EFTs IN your bank account or Checks IN your office within 3-10 business days you are not sending claims properly.  We want to take advantage of the Auto-Adjudication process that is going on! More than 85% of your claims should be going through this auto-adjudication process. Think about this for a second, only your claims with major and some basic services should be having to be seen by a human being.  Human beings have to review any claims that you write on or send with attachments.

Here are a few tips on how to use auto-adjudication to your advantage:

  1. You must be sending electronic claims.
    1. If you are not sending electronic’s 2018. Get on this now!
    2. Any handwritten claims at this point are frowned upon by insurance companies and will not be processed in a timely manner.
    3. Know which clearinghouse you are using to send electronic claims.
  2. Verify your patients’ insurance coverage PRIOR to their visit.
    1. You must be sending claims to the correct insurance company the first time.
    2. You are losing money daily if you are not verifying insurance due to denials.
  3. Do not write on the claim form unless necessary!
    1. I see this all the time and ask office managers to leave the remarks section blank unless the procedure filed needs an explanation or narrative.
    2. Notes about an account or how many times you called on the claim do NOT need to go in the Remarks section.
  4. When sending attachments, make sure you send the right attachments and explain why in your narratives.
    1. Even going to a consultant, the claim will be paid in a timely manner if your information to back up your procedure is easy to find.

Auto-Adjudication Is Here to Stay

Auto-adjudication within the dental insurance companies and will not be going anywhere anytime soon.  Take advantage of this knowledge, but also know computers do make mistakes. Make sure your dental billing coordinator or check poster knows how to catch the mistakes made by a computer.  Also, have them track your claims to make sure you are being paid within 3-10 business days.


– Davy Clay

Dental ClaimSupport

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