Common Errors in Dental Insurance Eligibility Verification and How to Avoid Them

Being knowledgeable about the common errors that can occur when verifying dental insurance eligibility can help you take steps to avoid them and improve the process.?

Verifying patient insurance eligibility for dental services helps practices improve billing processes, avoid late payments and denials, and enhance patient care. However, several errors can occur during the dental insurance eligibility verification process. Being aware of these errors can help you ease potential problems and ensure accurate verification.

Errors in Dental Insurance Eligibility Verification

Here are some common errors to watch out for:

Outdated or incomplete patient information

Outdated, missing or incomplete information can lead to incorrect eligibility determinations and denials. Mistakes that can occur include misspelling the patient’s name, inputting the wrong insurance number, or other data errors.?

It's crucial to ensure that the patient's details, such as name, date of birth, and insurance identification number, are accurate and up to date. Make sure to ask them if any of their personal information (name, address, or employer) has changed since their last visit. Double check the information. Have a dedicated person on the job.

Not verifying coverage details properly

Neglecting to verify all relevant coverage details can result in errors. It’s important to thoroughly review and confirm the patient's coverage to ensure accurate claims processing and prevent errors that can lead to claim denials or unexpected bills for patients. Confirm the patient's coverage status, any waiting periods, annual maximums, limitations, exclusions, and whether specific services require preauthorization or predetermination.?

Determining the patient’s benefits before they come to the office is the best way to make sure all of their information is up-to-date, how much of the procedure their insurance will cover, and if their benefits are still active. Dental practices are increasingly relying on professional insurance verification services to streamline this process.?

Misinterpreting coverage benefits

Inaccurate benefit interpretation can lead to errors in claim submission, treatment planning, and financial estimations. Verifying benefits is a comprehensive process that ensures the services you provide will be covered by the patient’s insurance. It involves thoroughly examining the patient’s insurance status, copays, deductibles, out-of-pocket maximums, and specifics of what is covered under their plan as well as any limitations on specific procedures.?

Checking all the clauses and provisions in the dental insurance plan is crucial. For example, consider the missing tooth clause which stipulates that the dental insurance plan will not cover any prosthesis replacing a tooth that has been extracted before the plan’s effective date.? When verifying insurance coverage, always ask if the plan has it, especially if any prosthetic treatment is planned.

Lack of preauthorization/predetermination

Some insurance policies require prior approval for certain services to ensure they are medically necessary before they agree to cover them. Most insurance policies require prior authorization for complex and costly dental procedures such as oral surgery, periodontal treatment, endodontic treatment, crown/bridge/inlay/onlay work, implant/implant-related services, orthodontics, and dentures/partials. Coverage will not happen if the necessary preauthorization or predetermination is not obtained, leading to delays in treatment or financial issues for patients. Make sure to check the patient’s plan for pre-authorization requirements.

Failure to verify changes in coverage

Policy updates, employment changes, or other factors can lead to changes in patients' insurance coverage. If you don’t verify patients' eligibility regularly, you can miss these changes, result in claim rejections or unexpected patient responsibilities. To avoid this Verify the patient’s coverage during subsequent visits or when there are significant gaps between appointments, This will ensure you have up-to-date coverage information.?

Communication problems with payers

Errors when communicating with the insurance company can cause confusion and delay billing and claims processes.

Making phone calls to the insurance company to confirm the patient information collected is an inherent part of the insurance verification process. It involves communicating with the company’s representative to check matter like:

• whether the dentist is in-network for the patient’s specific plan
• if the policy is active and when it expires
• the patient’s copay and deductible (if applicable)
• prior authorization requirements, requirements, and
• if any other additional documentation is needed

It's important to ensure clear and accurate communication. One advantage of having patient eligibility verification handled by experts is that they will ask questions that are relevant to the specific payer from previous experience. Document and maintain records of the information exchange or correspondence for future reference.

Not maintaining documentation

Insufficient documentation of the eligibility verification process can lead to confusion and claim disputes later on. Keep detailed records of the verification dates, contact person details, coverage information and any specific notes or authorizations obtained. In the event of disputes or patient inquiries, this documentation can serve as evidence.

A smooth eligibility verification process depends on have effective protocols in place to determine patient coverage and benefits, preventing these common errors. Outsourcing dental insurance verification to experts can reduce the likelihood of claim denials or financial complications, ensure seamless billing processes, boost your revenue cycle, and improve patient satisfaction.?