How to Better Understand the Dental Claims Billing Process?

After a patient is treated by a dental care provider the dental claims billing process begins. Read and discover this a comprehensive guide to the dental claims process.

The dental claims process can seem daunting. This is especially true if it’s an unfamiliar process or paperwork is a low priority.

Here’s our basic a step-by-step blog post that will cover away from any worries your practice might have.

Any dental practice will wish a price-effective, accurate, and quick dental claims billing process for it to be paid as quickly as possible.

Patients Registration

When someone calls and wishes for an appointment and they are patient new, they have to give their insurance information before registering with any dental provider.

A practice should examine the patient is qualified to get dental care from them doing this will increase up your dental billing processes right off.

Accountability for Payment

Dental insurance is different from plan to plan and provider to provider. It is necessary to establish early on, who manages what when it comes to dental billing.

It’ll save your practice so much or a huge time. Your practice will have to examine the cover of every patient to discover out who is accountable for every component of the bill when the bill is issued.

In most instances, the patient will have to cover some of the prices and the rest amount is provided by the provider of insurance.

When the Patient Comes

If a patient is new your practice administrative staff or the reception will have to speak the patient to fill out a few forms. If they are daily, then examine with them that their information hasn’t modified.

The patient should present a valid insurance card. You’ll also have to tell the patient to display some government-issued photo ID proof, like the driver’s license or the passport.

Every practice is different in regard to the gathering of co-payments from a patient. Some clinics choose to collect when a patient arrives with others when the appointment of a patient has been ended.

dental claims billing

When the Patient Left

This is when your practice forwards the dental report of the patient to its dental coder. This information is taken and places into dental code. It is important to input this data correctly.

There are common errors, practices that can ignore, like under coding and over coding.

A report is created. This has information about the demographic information and dental history of the patient. For example, contact information, gender, and date of birth. This is known as superbill.

The superbill will display the dentist's name, the patient, why they want medical attention, and the price. It also displays the name of the dental practice and the applicable dental codes for the medical and diagnosis procedure.

This bill is then sent to the dental biller. Generally, this is electronically sent with a software tool, although sometimes it’s accomplished on paper.

Creating Dental Claims Billing

The practice then forwards the bill to the payer. The will cover what the practice anticipates them to pay. This is as per the contract of the patient with their provider.

When the dental claim is generated by the practice, it is also their accountability to make sure that the application is coding and format compliant. There are certain guidelines that the practices need to follow.

These are by the 1996 Health Insurance Portability and Accountability Act (HIPAA) and Inspector General (OIG) office.

Electronic vs. Manual Dental Claims Billing

The HIPAA needs that all dental bodies covered by the Act have to electronically submit the claims. But, there are exclusions, so it’s worth examining those.

Manual claims tend to have additional issues, take extra time to finish, and take longer to process. This saves time, effort, and money. If you’re managing with big organizations like Medicare or Medicaid, you can forward your claim to them.

But, otherwise, this is where we come in to take the pain of the billing away. Every insurance payer comes with its personal formats and the guidelines for dental claims billing. We can bargain with those for your dental practice.

Time of Evaluation

This is where the bill payer arbitrates the claim to determine how much to reimburse and if it is valid and compliant. It’s at this point that an application might be rejected, denied, or accepted.

If the claim is accepted, this doesn’t signify the whole bill is paid. It just signifies the funds are settled as per their policy with the patient.

Sadly, coding issues can result in the rejection of the claim.

If that’s the instance, there’s a chance to again submit the application with the right detail. If insurance of the patient does not cover a procedure, it’s generally denied. This can arise if the patient has a condition pre-existing.

The dental claims process doesn’t have to provide your practice or your staff tensions. DentalRCM is here to make your life simple and to save you money and time. Call us today to discover out how we can assist you. Our toll-free number is (888) 315-2050.