Our mission is to assist and support your practice with collecting and resolving insurance claims issues, so you get the maximum funds that are owed to your office.
Our experts will provide an amazing service that properly matches procedure codes with required supporting documentation that will reduce denied claims.
This ultimately allows for fewer rejected claims and quicker turnaround time to maximize your treatment payouts.
(Insurance Verification is offered and quoted as a separate service)
Dental insurance claims and billing are essential processes in the dental industry that involve submitting claims for dental services provided to patients and receiving payments from dental insurance companies. Here's an overview of how the dental insurance claim and billing process typically works:
1. Patient Registration and Verification:
When a patient visits a dental office, their insurance information is collected and verified. This includes the patient's insurance ID, group number, and policy details.
2. Treatment Planning and Documentation:
The dentist examines the patient and determines the necessary treatments. These treatments are documented in the patient's dental records, including the type of procedure, date, and any supporting clinical notes.
3. Treatment Coding:
Each dental procedure is assigned a specific code, usually according to the Current Dental Terminology (CDT) or American Dental Association (ADA) code set. These codes are used to identify and describe the services provided.
4. Claim Submission:
The dental office staff or billing department prepares a dental insurance claim using the patient's information, treatment codes, and any required supporting documents.
The claim is then submitted to the patient's dental insurance company either electronically or through paper submission. Many dental offices use electronic claims submission for faster processing.
5. Insurance Review and Adjudication:
The insurance company reviews the submitted claim to ensure it meets their guidelines and policies.
The insurance company determines the patient's coverage, including deductibles, copayments, and maximum benefits.
The claim is processed, and the insurance company calculates the amount they will pay based on the patient's plan and the provider's contracted rates.
6. Explanation of Benefits (EOB):
After processing the claim, the insurance company sends an Explanation of Benefits (EOB) to both the dental provider and the patient.
The EOB details the services covered, the amount paid by the insurance company, and any patient responsibility (deductibles, copayments, or non-covered services).
7. Patient Billing:
If there is a patient responsibility, the dental office bills the patient for the balance due. Patients are typically responsible for copayments, deductibles, and any services not covered by their insurance plan.
8. Payment Posting:
Once the patient makes their payment, it is recorded in the dental office's financial system.
9. Appeals and Follow-up:
If there are discrepancies or denials in the claim, the dental office may need to follow up with the insurance company to resolve any issues. This can include submitting additional documentation or appealing denials.
10. Record Keeping:
All records related to claims, payments, and patient interactions must be maintained for reference, auditing, and compliance purposes.
It's important for dental offices to have knowledgeable staff or billing professionals who are familiar with dental coding, insurance policies, and claim submission procedures to ensure accurate billing and efficient reimbursement processes. Additionally, staying updated with changes in insurance policies and regulations is crucial to maintaining a smooth billing process in a dental practice.
LET OUR EXPERTS RESOLVE YOUR INSURANCE CONCERNS!