Understanding the Lifecycle of a Dental Claim: From Submission to Payment

Having a clear understanding of the dental claim process is key to effective practice management and ensuring timely reimbursements. Here’s a comprehensive guide to help navigate each step effectively.

‍Eligibility

This crucial first step sets up the entire claim process for success. Running eligibility verification provides insights into what services patients are eligible for and enables providers to have informed treatment conversations. Check eligibility for all upcoming appointments days in advance or in real time without tedious administrative work.

‍Claim Submission

Once dental services have been rendered, it’s time to prepare and submit the claim. Automated claim submission tools make this process easier by gathering required claim information, identifying any errors that might cause delays in processing, and enabling claim submission from the practice management software.  

‍Attachments

When submitting a claim to insurance payers, it is important to understand the additional documentation requirements for each procedure code to increase acceptance rates. Automated attachment solutions identify when documentation is required for any payer, eliminating rework and saving time and money. 

‍Claim Status

Once submitted, the payer will adjudicate the claim. At this point, monitoring is necessary to avoid surprises and delays in claim acceptance. Using a claim status solution provides a peek behind the scenes as the claim moves from submission, to processing, through payment and ensures quick action can be taken to maximize practice revenue. 

Claim Payments (ERAs)

After the insurance payer has reviewed the claim, an Electronic Remittance Advices (ERA) document is sent back to the provider, summarizing the payments made for dental claims and detailing what has been covered, denied or adjusted. Utilizing ERAs vs. traditional paper EOBs provides increased speed for providers and helps support better cash flow management.

‍Merchant Services

Meanwhile, providers can begin collecting payment from their patients. Providers can utilize Merchant Service tools to collect payments at the time of service with tools like Apple Pay and payment terminals. And additional features like text-to-pay allow providers to offer a modern solution that makes payments easy for both the front office and patient.

‍Patient Statements

Finally, providers must send a statement to their patients for any remaining unpaid fees. Electronic statements offer a convenient way for patients to view and pay their bill with just a few clicks.

‍Conclusion 

By understanding and effectively managing the lifecycle of dental insurance claims, practices can see improved cash flow and enhanced patient satisfaction. Regular training for administrative staff on the claims process and updates on insurance policies can further streamline operations and reduce the likelihood of errors.  

DentalXChange’s RCM solutions provide automated tools that help practices efficiently oversee and manage the entire lifecycle of dental insurance claims. Head to dentalxchange.com to learn how to accelerate your business, unlock new potential, and streamline your RCM workflows.    

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