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Insurance verification services for dental practitioners
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Insurance verification services for dental practitioners


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Outsourcing companies provide comprehensive insurance verification services to help dental practitioners check out patient coverage benefits before treatment is provided.

Published in: Economy & Finance, Business

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  • 1. 2013 Insurance Verification Services for Dental Practitioners Outsource Strategies International Follow:
  • 2. Suppose a patient comes to your dental practice for some denture work and your staff do not check the patient’s benefits because they were too busy with some other important work. When you submit the claim, the insurance company denies it, saying that the plan’s Explanation of Benefits (EOB) does not list the service you have provided on the grounds that it is cosmetic in nature. In this case, you would be forced to bill the patient for the non-covered charge. Such issues can be avoided is you contract with an outsourcing company providing insurance verification services for dental practitioners. With a dedicated team conducting eligibility verification, every detail of the patient’s insurance would be checked before the treatment is provided so that no information is missed and patients can be informed in advance that the service is not covered by their plan. Efficient patient eligibility verification services go a long way in ensuring timely reimbursement for dental practices. Dental Insurance Eligibility Verification Services Offered Dental Insurance Coverage Verification – The verification team will check whether the patient is eligible for dental insurance under employee coverage (coverage for full-time employees of an organization), dependant coverage (coverage for the legally married spouse of employee or dependent child for whom the employee or employee’s spouse is the legal guardian or custodian) or group coverage (coverage for members of societies, employees of a common employer or professionals in same group). Insurance verification services would also involve checking any changes that have occurred in coverage due to change in status (for instance, change in legal marital status, change in the number of dependent children, and so on). Other details verified are: • The date at which the coverage will be effective and if the insurance company specifies a waiting period (period during which the company does not give payment for certain procedures) • The date at which the coverage ends and whether the patient holds CORBA coverage for the continuation of the plan • If the patient has creditable coverage for reducing the pre-existing exclusion (exclusion of benefits for a health condition that happened before the coverage begins) period • If pre-authorization may be necessary for certain non-emergency services. For instance, some insurers require pre-authorization for starting treatment for prosthetics (dentures and bridgework), TMJ therapy, root canal therapy or orthodontics, single crowns and extensive gum treatment. • Pre-certification and pre-determination details Dental Insurance Benefit Verification – Most dental insurance companies break down their covered services into three levels such as preventative, basic and major and specify a percentage of benefits for each of these. Insurance verification
  • 3. specialists will verify the level the services specified in the patient’s claim and the percentage of benefit. They will also check whether the patient holds dual dental insurance and the percentage of benefit assigned by each insurance company. Other things verified during benefit verification are -If the patient’s dental insurance plans include plan exclusions such as a missing tooth clause (if the tooth of the patient is lost before the coverage began, payment will not be given for implants, crowns or bridgework done in that area) or downgrading (downgrade composite fillings for amalgam fillings on molar teeth so that the payment will be made only for amalgam fillings) -In network or out-of-network (not contracted in insurance plan) dental care, deductibles, co-payments, and out-of-pocket expenses -Necessary documentation -Claim submission information: processing requirements, phone number, address, fax number, and payer ID. Dental insurance verification services usually form part of the comprehensive array of services provided by a professional medical billing company. With the right service provider, dental practitioners can reduce claim denials and improve their collections.
  • 4. About Outsource Strategies International Outsource Strategies International (OSI), based in Oklahoma, offers professional medical insurance verification services for group practices, specialty practices and hospitals of all sizes. Our verification services can save your time and money and ensure quick reimbursement. If you have a specific question about our insurance verification services, call us at 1-800-670-2809 Visit us at: