The process to estimate insurance coverage for your patients can be a challenge at times and providing accurate estimations of insurance coverage can often feel like it requires a master’s degree in dental insurance. Every savvy insurance coordinator will tell you the challenge of insurance estimations is within the details of the patient’s coverage. Eligibility, maximums, deductibles, network participation, fee schedules, coinsurance, downgrades, frequency, limitations, dual coverage and coordination of benefits are just a few of the considerations that must be taken when providing the patient an accurate pre-treatment estimate.
It is important to consider multiple insurance plan factors for coverage when determining your patient’s financial readiness before services are rendered. I refer to this financial readiness process as “Know Before You Go” and I encourage every office to implement a solid protocol for both identifying and communicating financial readiness with the patient. One tool that should be in every practices wheel house is the pre-treatment estimate claim submission.
Pre-treatment estimate claims can provide more than just authorization to perform dental care services, these notices from the insurance carrier will also provide some insight into the amount the carrier is estimating to pay for the treatment you have proposed. If your office routinely submits Pre-Treatment Estimate claims, the tracking of open claims is a process that should be handled similar to your service claims.
Over the years, I have witnessed a number of clever systems for tracking open pre-treatment estimate claims. From systems which involve the storing a copy of the pre-treatment claim, to flagging the patient chart with a note, to keeping a binder with details on open pre-treatment claims. It never fails that these systems require extra intervention and hours of time to maintain.
Today, I would like to provide you with a simple solution for managing your pre-treatment estimate claims that are pending with the insurance carrier. Easy Dental provides a report which is quick to produce and simple to read. The addition of this report will enhance your system for tracking pre-estimate claims in ways that may save time when compared to the systems that are in place now. Here are some details for operating the Pre-Treatment Estimate Report that will help you better engage in the “Know Before You Go” process.
A report that should be on every office’s radar: The Pre-Treatment Estimate Aging Report
The Pre-Treatment Estimate Aging Report is designed to provide you with a list of claims that were sent to the insurance company for pre-authorization to which a response from the carrier has not been received. The list of claims can be filtered by time out to the insurance carrier – over 0 days, 30 days, 60 days or 90 days. The claims are provided in order by insurance carrier for ease of reference when contacting the carrier to obtain a status update.
- Open the Easy Dental Reports screen.
- Open the Account Reports menu and select Pre-Treatment Estimate Aging.
- Set the filters for the report.
- Click OK to generate the report.
Interpreting the information on the report
When the report is generated, in contains insurance carrier details (shown in red below), patient and claim information (shown in blue below), as well as aging totals in brackets at the bottom of the report.
