Navigating the Dental Insurance Maze

As a practicing dentist, I’ve learned that the real challenge often lies not in the operating room but in managing the complex maze of dental insurance. Trust me, this part is no cakewalk, but it’s an integral part of our profession. The way we navigate this maze directly impacts our practice, collections, and account receivables (AR). I’m here to share some of my personal experience and strategies to help you manage this complicated yet crucial aspect of our profession. Plus, I’ll also give you an idea of what could happen to your collection percentages once you invest in an outsourced dental billing solutions platform.

The labyrinth from claim submission to reimbursement

Let’s face it, managing dental insurance claims is like traversing an intricate maze. From submitting a claim, addressing any potential hiccups in the approval process, to receiving final reimbursement, there’s a regimented process to follow.

To start, you need to submit your claims correctly. This involves verifying the patient’s insurance information, understanding the coverage, coding the procedures accurately, and including all the necessary documentation. This might sound overwhelming, but trust me, it’s all about understanding the process. Sometimes, it’s helpful to use a list template to better visualize the process step by step:

1. Verify patient insurance terms before the appointment
2. Ensure that treatment is covered under the times and parameters set in the upcoming appointment
3. Accurately code every procedure during treatment
4. Make clinical notes that are legible and relevant to treatment
5. Attach intra-oral photos or x-rays as needed
6. Submit claim to insurance
7. Follow up on denials and/or rejections as they come in, don’t wait

Looking at this list, it’s easy to see how this task doesn’t end with claim submission. It’s equally important to track these claims to ensure they are being processed in a timely manner. It’s quite common for claims to get lost in the shuffle or be denied due to minor errors. Vigilance is key to getting 100% of what you’re rightfully owed.

The dental insurance reimbursement timeline

Reimbursement can be an entirely different ballgame. Depending on the insurance company, it could take anywhere from 15 to 45 days to receive your payment. Not to mention the potential negotiations process involved if the claims are not paid in full. This whole process can be time-consuming and frustrating at best. If your claims aren’t being sent correctly, you could end up waiting even longer to get what you’re rightfully owed. Here are the key differences that could affect whether or not your claim is paid:

• Rejection: the claim is missing patient information such as correct birth date or uses old, obsolete claim forms
• Denial: the claim has ambiguous or difficult to understand narratives, and inaccurate dental coding

Knowing these differences is just half of the battle. Implementing a training strategy to go after unpaid claims isn’t always easy. What if there was a better way?

Increase collections and decrease AR through dedicated outsourcing

To manage the maze most effectively, outsourcing has emerged as a promising solution. Outsourcing the dental insurance claims process has its advantages and can be a real game-changer for your practice. eAssist Dental Solutions is a platform suite of practice management tools that works to help you succeed, including:

• Pre-appointment readiness and insurance verification
• Patient scheduling and recall management
• AR for dental insurance and patient portion
• Access to Practice Booster‘s CDT code resources
• Dental accounting
• And more

Now, let’s talk more about the outsourced dental billing process in detail.

Why outsource dental insurance processing?

Outsourcing can streamline the claim submission process. Experts in dental insurance claim submission know the ins and outs, including the common mistakes that lead to denials or delays.

• Handle submission from beginning to end
• Maintain follow ups to insurance companies for any errors
• Automatic payments and AR management worked for you

The quick turnaround times associated with efficient outsourcing result in quicker reimbursements, thereby reducing your total dental insurance AR. Also, the tedious task of follow-ups and negotiations for denied or partially paid claims is handled by your dedicated team.

More importantly, outsourcing allows you and your staff to focus on what you do best—providing incredible dental care to your patients. Imagine the impact on your practice when you don’t have to worry about paperwork and can devote more time to patient care. Your staff will thank you for this extra pair of hands. There’s no bigger benefit than peace of mind.

Navigating the dental insurance maze

Mastering the dental insurance maze is a necessary skill for any successful dental practice. It’s a complex and often exasperating process, but it’s possible with the right strategies and solutions. eAssist was created to help navigate this maze for you, and become a partner in peace of mind as well as profit. This is why I continue to use it in my own practice to submit claims work aging. Your eAssist platform team is dedicated to overseeing your AR to increase collections, all without the need for hiring additional staff. In fact, you can then focus on retention for your current staff through continuing education, additional in-office resources, and simply having more time for patients.

Take it from someone who has been in the dental insurance trenches: a smooth sailing dental insurance process is not a far-off dream. It takes understanding, vigilance, and strategic decision making, but I promise you, it’s worth the effort. And remember, at the end of the day, it’s all about providing the best care for our patients. And isn’t that why we’re in this profession in the first place?