Benefits of Electronic Real-Time Eligibility :

It may not be surprising to learn that two-thirds of denied dental claims are linked to eligibility issues, and many of those errors are rooted in either a failure to check eligibility or the use of inaccurate eligibility data. That is why eligibility verification is an important step, even for existing patients. Insurance plans shift frequently and patients are not always aware if—or how—their benefits, have changed.The first step to having a healthy revenue cycle is for office staff to check with insurance carriers on the eligibility and benefits of patients the day before walking into a practice each day. Real-time is by far the most efficient verification of dental insurance breakdowns and continues to be one of THE most important tools in a practice, the learning curve for this step is small, and the payoff is huge. The process requires engaging the provider and payer into simplifying the eligibility and benefits in real-time.

There are several ways you can check eligibility:1. Go to insurance carrier’s website.2. Fax-back of eligibility.3. Call insurance carrier4. Use your clearinghouse real-time eligibility process

Much of eligibility and benefits process can now be done from a clearinghouse, for multiple payers in real-time, which greatly reduces the number of time-consuming phone calls to payers and the number of websites to visit. Additionally, it can be done the day before the patient appointments, allowing office staff to focus on patient attendance and care during working hours.By verifying eligibility and benefits electronically, a dental office can improve claim accuracy and patient payment responsibilities. Therefore, you not only start your claim process correctly, you also set the proper expectations for your patients. Furthermore, you can retain a permanent record of patient eligibility information. As a result of electronic verification facilitated through our partnerships with clearinghouses, dental offices may experience faster turnaround times and fewer returned or denied claims due to eligibility issues. Inefficient systems and Inaccurate information at the start of the claim process, are major contributors to poor cash flow, which is detrimental to the financial stability of a practice. Make sure to spend the proper amount of effort before the claim is submitted to ensure the best possible remittance collection. Below is a list of items that checking eligibility enables an office to do before submitting a claim.

BENEFITS: 1. Verify patient has coverage and if, in network or out-of-network.2. Turns 20 minute call into 15 second transaction.3. Verify coverage percentages breakdown.4. Verify if annual maximum has been met, and how much is left.5. Verify deductible amount and if applied yet.6. Verify frequency limitations of exams and x-rays.7. Verify crown frequency.8. Provide a more accurate estimate to a patient BEFORE treatment is started, which enables the

staff to collect more accurately at time of service.9. Enables Administrative Simplification.10. Provides easy online access that lets you view, scan, print, and download information. 11. Elimination of eligibility and benefit-related denials.12. Ability to seat more patients as case acceptance rates rise.

Dental providers no longer can afford to rely on outdated processes and workflow models to serve and develop their patient bases, learn the importance of moving from a paper based system to an electronic based system to simplify eligibility.