In Dental Billing, Insurance Verification

There’s a good chance that you think that when you create a dental claim, it will be processed and payment will be sent. This just isn’t true.

At Dental ClaimSupport, we’ve spoken to countless clients, many of whom actually didn’t know this was an issue at all. As an outsourced dental billing company and working with hundreds of offices, we have the ability to work with many clearinghouses on a daily basis and make sure newly created claims are processed and paid as soon as possible.

This article will dive into claim submission as a whole and explore the 6 main misconceptions of claim submission. These 6 misconceptions hold dental practices back from being able to collect more payments quickly. This article will help you understand the process of claim creation to submission, making sure your claims make it to the insurance company correctly.

 

Misconception #1: All dental submissions make it to the insurance company.

Truth: Not quite! There are a number of reasons dental claims don’t make it to that final destination. In fact, roughly a third of claims sent never get to the insurance company the first time. 

Insurance verification, data entry, and Payer IDs go hand in hand with each other and  all play major roles. They ensure your claim makes a swift journey to the insurance company to get processed and paid. 

Insurance Verification – Is the process of checking a patient’s insurance coverage and benefits prior to the date of service to ensure coverage is active and to receive a full breakdown of a patient’s benefits. Once you have verified a patient’s benefits and coverage, that data needs to be entered into your dental software. 

Data entry is key. Not only entering the patient insurance information such as plan name, group number, ID number, but also the patient and subscriber geographical information must be entered correctly

For example, if the date of birth of the patient or subscriber is entered incorrectly then the claim will be rejected. Each payer, or insurance company, has a payer ID assigned, and its purpose is to ensure the claim is sent to the proper payer. However, the payer ID printed on the patient insurance card may be different than the one the clearinghouse has on file. 

When entering a new plan or payer, be sure to verify that the payer ID is entered correctly according to the clearinghouse data. 

Correct insurance verification and data entry are the golden tickets to paid claims.

 

Misconception #2: Claims go from my office to the insurance company directly.

Truth: Once you batch your insurance claims in your software and manually export them, the claims do not go directly to the insurance company. They first go to your clearinghouse. 

So, what is a clearinghouse? A clearinghouse is a middleman between your office and insurance companies. It’s an important distinction because your clearinghouse is what makes electronic claims work so efficiently. 

They are the aggregator of all your data, they scrub all the information for inaccuracies and most importantly ensure that your claims make it securely to the insurance companies. They also report any rejected claims back to your software and give you the opportunity to fix it for resubmittal.

 

Misconception #3: If most of the information is correct, then the claim will get to the insurance.

Truth: The clearinghouse attempts to catch any inaccuracies before it sends the claim to the insurance company.  In the event your claim does make it through the clearinghouse, insurance

companies will look for any reason to deny your claim.

If you are not using a clearinghouse or are looking for one that fits your practice, make your decision easy and compare what are the best dental clearinghouses out there. We suggest finding a clearinghouse ASAP, and you should be working in the clearinghouse daily! 

Utilizing a clearinghouse assures you are submitting clean claims the first time and you will receive more timely payments. No more claim delays = no more payment delays!

Remember, inaccuracies and incomplete information are sure-fire ways your claim immediately denies. There’s no arguing that the day-to-day at the front desk of a dental office is hectic. Things can feel rushed. It’s important to take the time to enter the patient’s information into the software correctly the first time. This is one of the single-most important things you can do to guarantee your claim is paid. 

 

Misconception #4: Once a claim is batched, it’s automatically submitted.

Truth: Batched claims are essentially dental claims that are in line to be sent to the insurance company. Once a claim is batched, it manually needs to be exported to a clearinghouse that will then send it to the insurance company. 

Batched does not mean sent.  Batching a claim places the claim in queue to be sent to the payer by use of a clearinghouse or directly. Let me reiterate that it is most efficient to use a clearinghouse.

 

Misconception #5: Clearinghouses automatically know where to send my claim once it’s received.

Truth: Clearinghouses are wonderful, yes, but they aren’t all-knowing. The clearinghouse relies on what’s called a payer ID to filter and shoot the claim to the correct insurance company. 

Payer IDs are 5 digit/alpha characters unique to each insurance company. If you have the wrong payer ID entered in your dental software for an insurance company, the electronic claim will not get there.

 

Misconception #6: Attachments for major and basic services are automatically included with claims.

Truth: Dental software does an amazing job at organizing and maintaining all practices’ patient and claim information. 

However, it’s up to the admin team/billing company to pull data from the software when claims need evidence to be approved. Evidence is usually needed for major and some basic services, such as crowns, bridges, implants, and scaling and root planning.

This evidence comes in the form of attachments like x-rays, periodontal charting, chart notes or narratives.

 

Evaluate Your Current Claim Submission Process

Now that you understand how dental claim submission works with clearinghouses, see if your claim submission process is deficient in any area. If so, remember these 6 basic claim submission misconceptions and implement the solutions to your process. Don’t continue to make the same mistakes and miss out on easy claim payments.

The ultimate guide to getting claims paid article is a great resource to determine if you are meeting your claim submission goals and receiving timely payments. 

Author: Josh Smith

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