Insurance Verification/ Dental Billing

Insurance Verification

Insurance verification is crucial to providing accurate patient estimates, submitting clean claims and getting reimbursements quickly, insurance verification is often a lengthy and frustrating process managed by front office staff. Any error or delay in verification can hamper patient retention and impact practice revenue.

Apex IV solution integrates advanced technology with the existing practice management system, streamlining the insurance verification process, eliminating common errors, and reducing phone calls and precious hours spent on hold by front office staff.

No extra work or double entry required.

  • Verify eligibility and benefit details specific to your needs, 3-5 days before patient appointment
  • Detailed benefit breakdown directly to your PMS system
  • Comprehensive integrated dashboard
  • Daily reporting and communication with front office staff

Claim Submission

Claim submission is a vital step in receiving timely reimbursement for services rendered. Submitting a clean claim, the first time ensures full benefits are paid in a timely manner. Understanding the different submission requirements set by payers is crucial to claim processing.

Our claim submission specialists understand what a clean claim looks like. We ensure the correct claim form and coding is used, and patient data, provider information, necessary attachments, and clinical details have been checked to be free of errors, mistakes, or omissions. It’s important to do everything possible to avoid denials in order to protect the financial health of your practice.

  • Review claim details for accuracy
  • Fix or add any incorrect or missing information
  • Add attachments to claims, including images, charting, clinical narratives
  • Submit claim to insurance payers daily

Claim Follow Up

After submission of a claim, a practice may lose track of a claim. Proactive claim follow up is necessary, in addition to resolving denials received by the insurance payers.

Many claims will process for payment without intervention, but many will need to be followed up on. Insurance billing is a complicated process that requires awareness and attention to detail from a well-trained staff member.

Follow up on claims should begin as soon as 7 to 10 after a claim has been submitted to an insurance company. Insurance management is very involved and detailed, regardless of the PMS used. Our experienced specialists understand the complexity of dental claims and follow a strategic process that aims to quickly unmask and resolve problematic claims.

Claim management is an important area of any practice, and when done effectively practices get paid faster and enjoy a healthy cash flow.

  • Analyze and track insurance aging 30/60/90-day reports
  • Follow up on all denied or outstanding insurance claims over 15 days old
  • Detect denials early, resubmit claims for resolution
  • Submit and manage timely appeals on denied services
  • Notate all claim progress directly in PMS

Payment Posting

Payment posting accounts for the payment received from the insurance payer against the claims submitted for the dental services provided. The process includes identifying the patient account, procedure, billed amount, paid amount, allowed amount, write-off amount, and any other pertinent details given on the Explanation of Benefits (EOB).

When issues like denials, mismatch of payments received from the insurer, patient payments, etc. are identified and resolved at the front line, it will smooth the entire dental billing process and your practice will register a better cash flow.

  • Gather and organize all EFT and paper check payments daily
  • Post all payments and adjustments to outstanding claims
  • Notate all claim related information, such as downgrades, frequency limitations, denied code, etc., to PMS at the time of posting

EFT Setup and Reconciliation

An EFT is an electronic funds transfer where the claim is deposited directly into a dental provider’s bank account. It eliminates the need to take anything to the bank to be deposited and cuts down on the amount of staff time needed to process claim payments.

According to the American Dental Association, an “EFT is the best way to ensure secure and timely claim payments from dental benefit plans.”

Most insurance plans offer ETFs for receiving claim payments; however, each payer has a different application process to set up EFT payments.

Once an EFT payment is received in your bank account, it needs to be posted into the PMS. Apex will reconcile these payments to ensure all funds deposited to the bank have been posted accurately to the PMS.

  • Bypass paper checks by enrolling doctors to receive electronic fund transfers for with all payers who offer EFT payments
  • Manage ongoing enrollment for new doctors and locations
  • Reconcile EFT payments between PMS and practice bank account

End to End RCM Solution

The revenue cycle starts from the moment a patient makes an appointment, to the point the balance is paid in full by either the insurance payer or the patient. Apex RCM solutions will help your practice align collection to production ratios, maximize profitability and cash flow, and allow your front office staff to focus on quality patient care.

Interested in Insurance Verification/ Dental Billing? Have questions? Contact us