Like the broader healthcare industry, revenue cycle management (RCM) has become increasingly complex for dental offices because of the multiple parties and timelines involved with billing.
Dental offices must manage the patient's portion of costs and insurance coverage while navigating any complications. Claims denials might occur for even the smallest reasons, like typos within patient information, impacting when dental offices receive reimbursement and hurting their cash flow.
An accumulation of small, overlooked losses related to claims adds up, threatening dental offices' profitability at a time when every dollar matters. Per an August 2023 report from the American Dental Association (ADA) Health Policy Institute (HPI):
Key Insight
Only about 50% of all offices perform insurance verification. However, adhering to a simple dental insurance verification checklist before providing treatment helps minimize RCM headaches.
If you confirm that your patient's insurance information is accurate, up-to-date, and correctly processed before treatment, you can minimize lost revenue, improve patient satisfaction, and reduce administrative burdens on your staff. Advanced insurance verification helps transform claims submission and processing into a 'rubber-stamped' process and formality compared to a time-consuming gamble.
Incorrect or missing information remains one of the most common causes of dental insurance claim denials. Double-checking patient information helps avoid surprises for both providers and patients.
Confirming dental insurance benefits in advance helps clearly communicate patients' out-of-pocket financial obligations, minimizing surprises and fostering trust through transparency.
Informed patients are more likely to meet their financial obligations and accept treatments when they understand costs upfront and can plan accordingly.
Preventing issues upfront eliminates time-consuming phone calls with insurance companies and reduces administrative burden on your staff.
Simple typos can cause immediate claim rejections
Lack of clear communication about coverage limits
Employment changes often result in new insurance plans
Patients seeking care outside their provider network
To streamline the verification process as much as possible, provide office staff with this easy-to-follow checklist. Following these steps ensures comprehensive coverage verification:
Start by confirming the patient's basic information, like their name and address, making sure to double-check spellings.
Confirm the patient's insurance information, including their provider, plan type, and policy number.
Check what treatments the patient's plan will cover to ensure they won't receive any surprise billings and your office won't need to chase down payments.
Determine the patient's deductible and co-pays to provide accurate estimates for out-of-pocket costs. Remember that deductibles and maximum benefits reset on January 1st.
Insurance plans may require patients to receive prior authorization for certain treatments. Confirm with payers whether any pre-authorization requirements must be met.
Patients seeking out-of-network care will likely encounter higher costs. Verification confirms whether your dental office is within their plan's network.
Insurance coverage can change due to employment changes or annual plan switches. Identifying these changes minimizes claims denials.
Implementing an insurance verification checklist may require more time when scheduling patients and confirming appointments. While this will require some adjustment, you'll reclaim time and reduce stress by minimizing claims issues and follow-ups.
Insurance verification requires a perspective shift—front loading some administration to substantially reduce post-treatment efforts. Staff will likely require dedicated training, and leveraging digital tools can help maximize effectiveness.
Performing insurance verification is necessary but time-consuming. Spending 20 minutes per patient isn't uncommon when handling all checklist steps internally. Offices looking to optimize these tasks often turn to specialists.
More than 20 years after pioneering the dental outsourcing industry, the Claims Crafter team currently processes an average of 55,000 eligibility/benefit verifications every day. We've grown to better meet our clients' unique needs as their partner in dental billing, insurance verification, fee schedule maintenance, and more.
We use your insurance breakdown forms and protocols
Gather all the information you need systematically
Enter details back into your practice management system
Attach existing plans or create new ones as needed
These services are provided for upcoming verifications (such as new-year bulk verifications) as well as same-day or emergency appointments.
With Claims Crafter, you will have at least two dedicated and trained full-time team members working only for your practice. We offer transparent transaction pricing and scale up or down according to your volume.
Dental insurance verification is the process of confirming a patient's insurance information is accurate and that their coverage and plan benefits align with intended treatment plans.
Dental insurance should be verified yearly and in advance of patients' appointments to prevent claims issues or denials related to incomplete or incorrect information.
Dental offices should conduct insurance verification—or outsource the process to specialists like Claims Crafter.
When evaluating dental insurance verification companies, look for partners that:
Contact Claims Crafter for a no-obligation consultation to discuss how our insurance verification and dental billing services can optimize your practice's productivity and profitability.
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