linkedin instagram facebook plus
Dental Claims

How a dental claim is processed

Posted by Taylor Rose on Jan 29, 2019

Processing claims are one of the most time-consuming parts of your daily routine, but it can be the most mysterious. We spoke with some of our claims geniuses at Tesia (Renaissance’s industry-leading clearinghouse) to break down exactly what happens from the time a dental claim leaves your practice to when the check clears.

First and foremost, there are many ways that a claim can be filed. The most used are…

  • Paper
  • Payer web portal
  • Practice Management Systems
  • Partnering with a Clearinghouse

Let’s take a look at the path a claim typically takes in each.

Paper

When a claim is submitted via a paper form it’s the provider’s responsibility to mail it to the insurance company. There are a few things that can go wrong here. If the dental claim isn’t filled out properly you could receive a rejection. Also, there is a possibility of claims being lost or damaged in the mail. This is the slowest of the four in terms of approval time, albeit it is considered the traditional way of claims processing.

Payer Web Portal

While this is one of the cheaper options, it’s by far the most time demanding. For every claim, you must navigate each insurance company’s website and enter each one by hand. In terms of your busy day and labor costs, this is one of the least efficient methods of processing for a high-volume office. It also does not increase your chances of getting paid faster compared to using a Practice Management System or partnering with a clearinghouse.

Practice Management Systems

Practice Management Systems are likely one of your most trusted tools. They are great for keeping track of patients and your practice’s schedule, and you can even submit your claims directly through most of them. Using only a Practice Management System costs around 50 cents a claim in addition to an attachment processing fee; which means the average dental practice spends up to $160 per month on processing claims and attachments. This is where third party, easy to use, systems like Remote Lite can save you thousands.

Partnering with a Clearinghouse

Once the claim is sent from one of the three methods above, it goes either to a clearinghouse or directly to the payer to be processed. Clearinghouses act as a connector; think of them as a Venmo or PayPal, bridging the transaction gap between two parties. With the symbiotic relationship between Tesia and Remote Lite, the process can take merely seconds. Remote Lite can also track your claim the way you would a package out for delivery, showing exactly where it is at all times. It also shows you why a claim was rejected if that is the case. While Remote Lite does much of the claims processing for you, it also shows you exactly what’s happening behind the scenes every step of the way.

Once a claim is entered in your Practice Management System it syncs to Remote Lite if you are one of our dental heroes! There the claim can be easily tracked, sent with attachments, and even processed in real-time giving you an answer in seconds. Instead of paying per claim or incurring the cost of attachment fees, Remote Lite combines it all for $49.95 a month.

It’s a common misconception that submitting the same claim via multiple thoroughfares will help get it approved faster; our industry superheroes have told us that is simply not the case. In fact, it will likely slow down the process and may cost you more money as a provider. More to come on that topic in a later blog.