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Tesia Clearinghouse

15 Things Insurance Companies Want Dental Offices to Know

Posted by Taylor Rose on Mar 21, 2019

Tesia clearinghouse is known throughout the industry for bridging the gap between insurance companies (payers) and dental offices (providers). In the spirit of that relationship, we decided to ask our industry leaders at Tesia what payers wish providers knew about claims processing.

To be fair, many of these examples not only make the job of payers easier, but they also help your claims move through the processing pipeline faster.

Claim Submission

  • ADA claim billing guidelines — Making sure that your claims adhere to the American Dental Association outline for claim submission might sound simple but running through that checklist can help claims get approved.
  • The benefits of EDI — It’s no secret that the future of dental is electronic claims processing. Submitting claims and attachments electronically allows insurance companies to track them and pay your office faster.
  • Knowing what attachments are necessary — Not all attachments are created equal. Depending on the type of claim you are sending, adding one that doesn’t need to be there can slow down the processing and subsequent payment.
  • Submitting a real-time claim — Remote Lite allows for claims to be sent while a patient is still in the office. The benefit of real-time claims is you can see whether they are accepted or rejected right away. 


Benefits

  • Coordination of Benefits (COB) can be submitted electronically — A COB is a claim where there are two policies at play, which could be with the same insurance company.
  • Benefits are best received electronically — Payers prefer to deliver benefit information electronically to your dental office. It helps to track the communication and get it in your hands faster. 


Contacting

  • Email vs. phone — The best way to communicate with an insurance company might not be over the phone. Reaching out over email allows a support ticket to be created and tracked, helping your issue get resolved efficiently.
  • Consult the website — Check the payer websites for any changes or notices. It might answer your question and save you time contacting them.
  • Check Remote Lite — Make sure you check your system for any notifications that might let you know a claim is rejected. Remote Lite also offers solutions to help change the status from rejected to accepted. 


Updating

  • Direct deposit is the move — The dental industry as a whole is a bit behind in this process. However, it is the fastest way to track and ensure you are being paid exactly what your office is owed.
  • Up-to-date Practice Management System — Making sure your Practice Management System is updated with the newest member IDs can spare a world of headaches. If that claim gets submitted under the old number it will get rejected by the payer.
  • Keeping patient info up-to-date — Make sure to review the patient’s insurance information on a regular basis to ensure all changes are updated in your PMS.  
  • Make sure you are using the current payer mailing address — Checking the Insured ID card for updates can ensure your claims are processed expeditiously. 


Policy information

  • Making the best use of a patient’s policy — The dental insurance policy is a vehicle to discuss treatment plans with patients and what coverages are available through their plan.  
  • Those with insurance will have a different treatment plan —  Individuals with dental insurance are much more likely to visit the dentist on a regular basis and be more compliant with treatment plans. If a patient gets regular preventative care, typically that helps avoid costly major services. Also, regular oral check ups can unveil other medical conditions that the patient may not know they have.