Do you end up with an Insurance coverage Declare Report that’s 5, 10, and even 40 pages lengthy? Have you ever just lately joined a follow with unpaid claims reaching again 4 years?!

The place do you begin?

There are lots of methods to sort out this massive but important problem. You’ll be able to print the studies immediately out of your follow administration software program and go line by line. You probably have third-party software program, you may pull a stay report and work from the highest by date of service, insurance coverage provider, and so on.

I joined a follow just a few years in the past with $400,000 of excellent insurance coverage claims. Inside a month, I had collected nearly 100% of that.

How did I do it?

Let’s dive in!

Growing older Report

I ran an Insurance coverage Growing older Report from our PMS, Dentrix. I then exported that report back to Excel and cleaned up the next columns:

• Date of Service
• Affected person Identify
• ID#
• Birthday
• Insurance coverage Provider

I used Excel to filter my outcomes by service date and first tackled the claims with the oldest date. It’s also possible to filter by the declare quantity, permitting you to sort out the most important greenback quantity first.

Insurance coverage Portal Entry

I started by trying up the declare I’m engaged on within the Insurance coverage Provider’s portal. Insurance coverage portal entry is vital in a dental follow’s workflow as a result of we don’t have 631 hours to sit down on maintain to ask a consultant to reply our questions.

Confirm Accuracy

If the declare doesn’t seem in your portal, don’t simply resubmit it! Confirm the affected person’s identify is spelled appropriately, and their birthdate is right.

TIP: Typically insurance coverage has the flawed birthday! At that time, you’ll have to get the affected person concerned to right it.

Verify the affected person was lively with that insurance coverage on that date of service utilizing your portal. Verify that your payor ID is right to your clearinghouse.

Resubmit

If all of this stuff are confirmed and corrected, resend your declare.

TIP: In case your insurance coverage portal lets you submit claims on-line, it is a excellent alternative to take action immediately!

Does the declare seem in your portal? What does the EOB say? Was it denied; ship an enchantment. Is insurance coverage requesting extra info?

I’ve realized [the hard way] that, as a rule, should you resubmit your declare attempting to ship in additional info, it will likely be mechanically denied. To make sure your declare might be acquired as a resubmission, you may name, fax, e mail, or snail-mail the provider with a brand new NEA attachment #, a duplicate of the declare with the declare # within the remarks part, AND a duplicate of the EOB.

It will assist their processing groups understand they should reprocess and never simply decline. Upon getting despatched one in every of these strategies, THEN resend it electronically.

Be taught Extra Now

Monitor Your Course of

In your Excel sheet, create a remark column. Inside there, you may add your notes on what was flawed with the declare and what motion(s) you took to have it reprocessed. These notes can then be copied and pasted into your PMS software program.

Proceed to your subsequent declare. Put aside half a day per week to focus in your excellent claims uninterrupted (if potential). Typically, you’ll have to name an insurance coverage firm to find out the standing, and that’s okay.

Sharing this info with you is to offer frequent causes for excellent claims. Bear in mind to confirm that the knowledge in your software program is right and that the affected person is lively. Extra importantly, solely resend a declare after checking all the explanations it may very well be denied first.

Wishing you cheerful collections and a one-page excellent insurance coverage declare report!

Concerning the Writer

Tiffany Yeckel, MAADOM

Tiffany Yeckel, a Virginia native, began in dental over 11 years in the past. She was impressed to work in dentistry due to her experiences as a affected person with the dentist, and he or she now manages the follow!

She enjoys with the ability to join with sufferers who’re present process procedures that she has skilled first-hand.

Tiffany has been a member of AADOM since 2019, acquired her Fellowship (FAADOM) in 2022 and Mastership (MAADOM) in 2024.