Your Dental Insurance Verification Guide & Checklist

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), practice income for GP dentists increased by just 2.2%, while expenses rose by 7% that same year.

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.

The Financial Impact of Dental Insurance Verification🔗

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.

Minimizing Claim Denials and Delays🔗

Incorrect or missing information remains one of the most common causes of dental insurance claim denials. These inaccuracies can stem from simple administrative mistakes or oversights, such as:

• Misspelled patient names or other information
• Patients misunderstanding benefits
• Not knowing a patient’s insurance provider changed following employment changes
• Someone seeking treatment outside their provider’s network

Double-checking patient information via insurance verification helps avoid these types of surprises for both providers and patients. By integrating the dental insurance verification process into your daily workflow, your practice can see to it that you’ve gathered all the necessary information upfront, so there’s less risk of errors when submitting claims.

Improving Cash Flow and Reducing Write-offs🔗

Even when insurance providers approve claims, dental offices bear the brunt of collecting co-pays and deductibles from patients. Beyond how this impacts patient relationships and satisfaction, outstanding balances represent a growing liability on your balance sheet. They also make extra work, like follow-up phone calls where staff must try to explain benefits and balances to busy patients.

However, confirming dental insurance benefits in advance helps clearly communicate patients’ out-of-pocket financial obligations, minimizing surprises on post-treatment statements and fostering trust through transparency. Patients know what to expect and plan for timely payment, while dental practices can tailor treatment and payment plans depending on a given patient’s circumstances.

When patients agree to costs they understand and can manage, they stay on top of their payments, and your cash flow remains steady.

Enhancing Treatment Acceptance and Revenue🔗

Informed patients aren’t only more likely to meet their out-of-pocket financial obligations; they’re also more likely to accept and adhere to treatments.

Understandably, patients may be reluctant to agree to treatment plans involving uncertain costs. But your dental office can easily assuage that reluctance by performing insurance verification ahead of treatment. Confirming patient benefits and clarifying what will be covered achieves much more accurate estimates, helping patients confidently commit to their treatment plans.

Improving Operational Efficiency🔗

Claims delays and denials lead to office staff wrestling with tedious, time-consuming tasks. Instead of attending to patient care and core responsibilities, they end up spending valuable time on the phone with insurance companies to straighten out and resubmit the inaccurate or incomplete information.

Moreover, if benefits aren’t confirmed ahead of time, staff may book patients for appointments that won’t be covered. This likely creates miscommunication, causes confusion, and denies valuable appointment time to other patients, which are outcomes that only risk patient satisfaction.

Spending some time to perform insurance verification in advance (or partnering with experts who handle the process for you) only leads to more streamlined, smoother operations. You’ll preemptively minimize issues with pending claims and patients’ appointments, and both patients and office staff will greatly appreciate it.

Promoting Pricing Transparency and Patient Trust🔗

All relationships depend on transparency, but—as one McKinsey report demonstrates—the last few years have seen surging consumer calls for transparent healthcare pricing.

In particular, patients may feel taken advantage of if not provided with accurate estimates before agreeing to treatment. In the long term, obscure pricing may lead to patients seeking other dental practitioners; in the short term, it causes confusion and dissatisfaction while increasing the chances of surprise costs leading to unpaid bills.

By verifying insurance, your dental office gains an opportunity to build rapport and trust by clearly explaining to patients what their policy will cover.

Incorporating a Dental Insurance Verification Checklist🔗

Dental office staff should directly integrate insurance verification processes into their daily workflow to minimize claims issues, build better patient relationships, and improve operational efficiency. However, with these clear benefits, why do only 50% of dental offices do so?

Ultimately, it’s because insurance verification is time-consuming. Calling payers may take 20 minutes or more between being placed on hold and confirming the deductible, co-pay, coinsurance, frequency limitations, covered services, plan minimums, and waiting periods of the patient’s plan.

To streamline the verification process as much as possible, be sure to provide office staff with an easy-to-follow checklist.

Key Elements of the Dental Insurance Verification Checklist🔗

Follow these steps to verify patients’ insurance:

• Patient information verification – Start by confirming the patient’s basic information, like their name and address, making sure to double-check spellings.
• Insurance plan details – Next, confirm the patient’s insurance information, including their provider, plan type, and policy number.
• Coverage and benefits – 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.
• Deductibles and co-pays – Determining the patient’s deductible and co-pays will allow your office to provide them with the most accurate estimates for their out-of-pocket costs. Remember that deductibles and maximum benefits reset on January 1st. Verifying insurance early in the year helps establish the financial responsibility for each patient’s routine preventative visits or treatment plans, so there are fewer surprises.
• Pre-authorization requirements – Insurance plans may require patients to receive prior authorization for certain treatments to receive reimbursement. Confirm with payers whether any pre-authorization requirements must be met, inform patients, and work with them to schedule the necessary appointments in advance.
• Out-of-network considerations – Patients seeking out-of-network care will likely encounter higher-than-expected costs. Insurance verification will confirm whether your dental office is within their plan’s network and provides an opportunity to demonstrate price transparency.
• Policy changes and updates – Insurance coverage can change for numerous reasons, with the most common being individuals switching providers at the end of the calendar year or following employment changes. Identifying these changes and adjusting patient information and treatment accordingly will minimize claims denials.

Implementing the Checklist in Your Practice🔗

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.

Put simply, insurance verification may require a perspective shift—front loading some administration to substantially reduce post-treatment efforts. Additionally, staff will likely require dedicated training on how to perform insurance verification, and leveraging digital tools or software can help maximize checklist effectiveness by reducing errors and synchronizing data across other platforms.

The Role of Technology and Outsourcing in Insurance Verification🔗

Performing insurance verification is a necessary but time-consuming effort. Spending 20 minutes per patient isn’t uncommon when handling all the checklist’s steps internally.

As a result, offices looking to optimize these tasks and adopt dental insurance verification best practices often turn to the specialists.

More than 20 years after pioneering the dental outsourcing industry, the Medusind® 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.

Using our QuickVerify™ technology, we make your staff’s life easier by following your specific protocols. We:

• Use your insurance breakdown forms
• Gather all the information you need
• Enter the details back into your practice management system
• Attach existing plans to patients or create new plans

These services are provided for upcoming verifications (such as new-year bulk verifications mentioned earlier), as well as same-day or emergency appointments.

And with Medusind, 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.

Contact us for a no-obligation consultation to discuss how Medusind insurance verification—or other dental billing services—can optimize your dental practice’s productivity and profitability.

Dental Insurance Verification FAQs🔗

What is dental insurance verification?🔗

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.

How often should dental insurance be verified?🔗

Dental insurance should be verified yearly and in advance of patients’ appointments to prevent claims issues or denials related to incomplete or incorrect information.

Who is responsible for insurance verification?🔗

Dental offices should conduct insurance verification—or outsource the process to specialists like Medusind.

What should practices look for in a dental insurance verification partner?🔗

When evaluating dental insurance verification companies, look for partners that:

• Integrate with your existing processes and technology
• Quickly gather all necessary information
• Attach existing plans to patients or create new plans
• Perform both new-year bulk verifications and same-day or emergency verifications