Insurance claims and collections is defined within the details of the billing process. When a claim is created for dental services, there is specific information which must be included on your claim submission, otherwise there is a near guarantee to receive a denial for that claim. Some details are more critical than others, for example, the absence of a number in the subscriber ID, a transposed digit in the date of birth or even the submission of the wrong last name can cause issues with claim processing.
A practice I have known for a few years had their insurance coordinator retire after 25 years working with the office. This insurance coordinator was everything for the billing team. She was responsible for creating insurance plans, entering coverage tables, sending claims and posting the remittance. She was like a machine – every action she took was with precision and ease, every response to an insurance request was natural and effortless. This insurance coordinator left the office well-equipped to handle insurance claims. The only problem the office has is finding the right person to take over the reign as insurance coordinator.
When a new insurance coordinator joins your practice, it is critical to review all claim billing details to ensure they follow your standards for insurance billing. One small change in your billing process could cause issues with insurance companies to delay or even deny claims. This delay of claims may not be noticed by the practice at first, as it could take 30 days or more to see the effects. The more proactive you are with the training and implementation of a new insurance coordinator is key to your continued insurance billing success. Here are some tips for reviewing key insurance claims details:
Insurance Profile Setup
Creating an insurance profile in Easy Dental requires a number of details. Here are the absolute minimum requirements you will need include for every insurance profile in Easy Dental to ensure timely processing of your claim with the insurance company. Please keep in mind, the documentation below includes the minimum requirements. Your office should have a clearly documented plan for entering insurance data which complies with all office policies and procedures.
In the Patient Banner, click the Settings button, then point to Maintenance > Insurance Maintenance. Select an insurance carrier on the list, and then click the Ins Data button.
Insurance Subscriber/Patient Profile Setup
Before creating an insurance claim, the minimum required details outlined below must be entered on the account. Please keep in mind, the documentation below includes the minimum requirements. Your office should have a clearly documented plan for entering insurance data which complies with all office policies and procedures.
The Patient Information dialog box is from the Patients toolbar by selecting a patient, and then double-clicking the patient information block.
The Insurance Information dialog box is by double-clicking the Insurance Information block.
Insurance Claim Submission: What is the Best Method of Transmitting Claims?
I strongly encourage all offices to submit their claims electronically. Electronic claim submission is the most efficient and reliable transmission of your insurance claims. The utility operates a 27-point check on your insurance claims to verify the details required for proper claim processing are included on the claim. Once claims are submitted, claim transmission reports are generated to provide confirmation of successful claim submission. These transmission reports are to be reviewed daily.
Insurance Claim Follow-up” What is the Proper Timeline to Follow?
There are times when even the perfectly detailed claim can run into issues with an insurance company. Timely follow-up on open insurance claims is a practice all dental offices should operate. Reviewing the Insurance Claim Aging Report on a weekly or bi-weekly basis will ensure that open claims are being paid on time.
Additionally, the Easy Dental Insurance Manager provides tools of insurance eligibility and claim status to alleviate the stress of managing open dental claims.
Dental practices that accept assignment of benefits rely on timely insurance payments to cover the cost of daily operations. When insurance payments are delayed for any reason, this could place undue financial stress on the practice. By keeping the insurance process detailed and submitting your claims electronically, you will ensure a higher rate of success. After all…
Details + Speed = Insurance Claim Success
If you have questions or concerns with detailing your insurance processes in Easy Dental, comment below or reach out to the Henry Schein One team for additional training.
David Broom is Senior Director of Product and Business Development. David has a master’s degree in Information Technology (IT) from the University of Texas in Dallas and has more than 35 years of experience from many global companies such as Hitachi Vantara, Methode Electronics, and Keane, Inc. In his current role, he is responsible for all aspects of the product management and field service teams at Henry Schein TechCentral, which identifies the ideal advanced technologies to meet the unique needs of the dental market and ensure that dental offices are using the right IT to be more efficient and effective.