We are talking about 5 things that will systematically change your practice collections once and for all. The most important thing you will learn is...
Also, we challenge you to repeat "Be a Better Dental Biller" 5 times fast. Can you do it without messing up?
You realistically should never have 1 single dental insurance claim over 14 days aging and we are going to show you exactly how to do it.
How to read an EOB
Hold insurance accountable for what they told us in eligibility verification
Write the perfect narrative
How to focus on projected monthly collections.
Filing dental claims can be a daunting task, especially if you're not familiar with the process. However, with a little preparation and understanding, you can make the process go smoothly and get the reimbursement you deserve. Here are some tips to help you file dental claims in the best way possible:
1. Verify their coverage. Before you even allow a patient to set foot in the dental office, make sure you understand what their dental insurance covers. Know your patient's plan's deductible, copayments, and maximum annual benefits. This will help you explain what the patient is responsible for paying out of pocket.
2. Keep accurate records for your patients. Make sure to keep all of your dental receipts (from vendors) and documents from referring specialty offices that had a part in your patient's care. These will be needed when you file your claim in some scenarios. Do not miss the post-op x-rays or the required clinical notes.
3. Submit your patient's claim promptly. Our best practice is to send claims immediately. Most insurance plans have a deadline for filing claims, usually within a few months of the date of service. If you miss this deadline, you may not be able to get reimbursed. Sending claims immediately also gives you a track record of initially sending the claim out so even if an insurance company says "no claim on file" you have proof you've sent out the claim with a tracer number. This is especially helpful if you are working on old claims that have exceeded the claim filing limit. You can still get paid for the claim because you have the initial claim information and it was submitted timely.
4. Over Communicate: When you send the claim don't assume that just because it is a basic or preventive procedure it doesn't require x-rays or attachments. Over-communicate with the insurance. It will never hurt to send more information, x-rays, or charting. When we say over-communicate, we mean to call the insurance incessantly until its adjudicated. Stay on top of it, the insurance company is banking on you NOT Staying on top of it.
5. Fill out the claim form accurately. Make sure to fill out the claim form completely and accurately. Double-check that all of the information, including dates of service, procedures performed, prior placement, and charges, are correct. Start with your ledger and the appointment itself. Create a guide for your front office team to audit and ensure you aren't leaving out important procedures that were completed. Most dental software has this digitally. We encourage you to verify the most current digital form is attached for claim submission. Many dental offices are using outdated ADA forms on the digital side because they simply don't know to check this. Take the time to call your digital dental software company and check your systems once a year for accurate attached forms.
6. Follow up EVERY 14 days. If you don't hear back about your claim within 14 days, don't be afraid to follow up. I would also venture to exclaim, YOU SHOULD demand an explanation. There are insurance commissioner laws to protect dental offices and the money the insurance company has to pay them, which require dental insurance companies to pay within 30 days. However, most dental insurance companies have automation for the adjudication of claims. Meaning they are paying out in 24-48 hours on claims. Help your patients understand their EOB if you don't they will think you are overcharging and
7. Anticipated collections. Do you know what this is? If your current team is not giving you this, there is a problem. When researching dental insurance claims your dental team should be asking what money is on the way and when it was sent. Anticipated collections should be shared with the dental office by the admin team at your dental office.
By following these tips, you can increase your chances of a successful dental claim. Don't let the process intimidate you – with a little preparation and effort, you can get the reimbursement you deserve.
The best tip we can give you is that your job as a biller is not just "send the claim" but focus on doing the right thing for the claim. Make a checks and balance list for yourself.
Dentistry Support ® provides remote support for dental offices nationwide. We serve the needs of any size dental office including those with Spanish-speaking needs on both the east and west coasts of the United States of America. Learn more.