Today’s changing insurance landscape places a number of unique demands on dental practices. With over 85% of dentists belonging to at least one PPO and working with insurance carriers, maintaining the relationship between the practice and the carrier is essential. Unfortunately for your practice, working with insurance carriers is not something you can “set and forget.” Instead, it’s an ongoing process, and dentists have to keep up.
Insurance carriers will periodically request your dental practice to validate practice information, whether it’s your address or what procedures you can perform. Your practice and your insurance carrier need to meet all state requirements, and in many cases, this validation process is part of that. If you do not respond to validation requests from your practice’s insurance carriers, you could face many penalties, including losing your credentialing with the carrier.
Credentialing and Recredentialing
Another time it’s important to be responsive and proactive with insurance carriers is during the credentialing or recredentialing process. Since carriers will not always reach out to tell you what is missing from your application or paperwork, it’s up to you to be responsive when you do hear of an issue. When you partner with a credentialing and recredentialing specialist like APEX, you will have an advocate on your side ensuring that you don’t miss any important deadlines or insurance carrier requests. We will take care of getting your paperwork in a row and contacting the carrier to ensure that everything has been received.
Your responsiveness also matters during the claims process. If you are waiting until the explanation of benefits arrives, you could easily be over a month into the life of the insurance claim. You should stay on top of all claim submissions and appeals using carrier websites, and if you get a claim denied you should immediately file a detailed appeal. 85% of all denied procedures are never appealed. Of the 15% of denials that are appealed, a whopping 75% are reprocessed and paid. You can’t afford to be nonresponsive when an insurance carrier denies payment.
Grow Your Practice with APEX
The experts at APEX Reimbursement Specialists can help you to explore the best insurance carrier options for your continued growth and sustained success. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.