In Dental Billing

Bottom line – as a dental office, you want your claims paid faster. You’re not collecting as much as you should and you’re tired of payment delays. We all use software technology to be more efficient and produce quicker results. The software technology that dental insurance companies have been using saves them money and gets your claims paid much quicker.

We already know insurance companies want to save money where they can, but in this case, it benefits dental practices as well! Auto-Adjudication is now the standard in the dental world and will continue to be so. With the current pandemic, many insurance companies could only accept electronic claims and process claims via auto-adjudication as physical claims processing centers were shut down for a while.  This allowed dentists to be issued electronic payments into their bank accounts during the shutdown time. 

The experience gained from the pandemic, in itself, will play a role in more insurance companies implementing auto-adjudication as part of the claims processing and an increase in types of procedures that may be processed via auto-adjudication. It’s time dentists and office managers really know what this means and how it can be used to benefit their practice.

WHAT IS AUTO-ADJUDICATION?

Auto-Adjudication is the process in which insurance companies’ computer software processes claims for them instead of a human being. Auto-adjudication uses advanced artificial intelligence software to scan for errors and approve, deny or change insurance claims. 

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 company (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?

How does auto-adjudication benefit the dental Practice?

Of course, a practice will get paid faster is the number one benefit. However, there are many other benefits to auto-adjudication. 

  • A decrease in the need for human review
  • Less claim rejections

The more specificity in CDT code language, increases the payer’s ability to auto-adjudicate. For example, many codes have been revised in recent years to distinguish the maxillary and mandibular arch within the code nomenclature language. Therefore, this allows for auto-adjudication of claims. Oftentimes, the arch treated was not indicated on the claim or not indicated properly in a format that computer software could read and process. As a result, the insurance payer had the need to request additional information (i.e., what arch was treated). This significantly delayed the claim and your reimbursement. So, as long as the practice submits correct, current codes and the claim is a “clean claim” then the claim may be processed more efficiently and paid within a number of days. 

GET CLAIMS PAID FAST WITH AUTO-ADJUDICATION

Your office only survives if you collect what you are producing, in other words – being paid for your services. If you are not getting preventive and basic claims paid with EFTs in your bank account or checks in your office within 3-10 business days then you are not sending claims properly.

If this sounds like you, you should take advantage of the Auto-Adjudication process.

On average, more than 85% of your claims could be going through this auto-adjudication process. Only claims with major services should require a review by a human being or dental claims consultant. Human beings review any claims that have a narrative included in the remarks section of the claim form or sent as electronic attachments.

HOW TO USE AUTO-ADJUDICATION TO YOUR ADVANTAGE

  •  Send electronic claims.
      1. If you are not sending electronic claims, implement this in your practice.
      2. At this point, any handwritten claims 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.
  • Verify your patients’ insurance coverage prior to their visit.
      1. You must send 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. It’s time-consuming to deal with claim payment delays. 
      4. Verifying insurance before a visit can give you an idea of how much the patient out pocket expense will be, which can be helpful information to relay to the patient beforehand. 
  • Do not enter comments in the remarks section of the claim form unless necessary.
      1. We 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. This type of activity only delays processing your claim. 
  • When sending attachments, make sure you send the correct attachments and explain why in your narratives.
      1. Even if the claim needs to go to a dental consultant for review, the claim will be paid in a timely manner if your information to support the necessity of  your procedure is easy to find, of diagnostic quality, and narratives are clear and precise.

AUTO-ADJUDICATION IS USED BY MOST INSURANCE COMPANIES 

More insurance companies are implementing the auto-adjudication process and applying to more and more procedures. While there are many benefits, as previously noted, also know computers make mistakes.

Make sure your dental billing insurance coordinator and any other team members who may be posting payments are aware of how to catch the mistakes. Careful review of the Explanation of Benefits (EOB) is necessary to ensure claims have been processed correctly. Track your claims to make sure you are being paid within 3-10 business days.

Auto-Adjudication is the new normal. Educate yourself on how to work with it to avoid mistakes costing you money and time. While trying to understand this technology, you should also learn more about whether or not claims are being auto-adjudicated and paid. You can learn all about How to Run an Outstanding Dental Insurance Aging Report on Dental ClaimSupport’s blog.

 

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