Carefully Review Insurance Claims

Sometimes after dental insurance pays a claim, you are left with a balance on the patient’s account—whether it’s a balance due or balance owing. Before you send a bill or issue a refund, make sure you understand the reason for the balance, and that means fully understanding the explanation of benefits.

Dental Insurance

After you carefully review the explanation of benefits, you may discover the patient’s insurance paid the claim incorrectly. It’s not uncommon to see out-of-network claims accidentally paid with in-network restrictions. While it’s not uncommon to see an out-of-network insurance company disallow the full fee charged, the out-of-network plan should allow you to pass along the uncovered amount to the patient. When the explanation of benefits shows otherwise, you know that a mistake was made.

However, if you process a lot of insurance checks, some in-network, some out-of-network, you can miss this oversight by the insurance company. One trick is to enter all in-network checks in one batch and then enter the out-of-network checks next. This will help you keep everything straight.

Another error to watch for is when your in-network fees do not match the most updated fee schedule. Sometimes the insurance company may fail to update their side of things, and you will have to notify them to have the claim reprocessed. Or, you may have submitted old fees because you failed to update your fee schedule—this is also a good reason to resubmit the claim with the correct fees.

Dental Benefit Claim Form

Finally, the insurance company may have paid correctly based on the information supplied, but you billed the wrong fee schedule altogether. This oversight commonly occurs when patients switch insurance companies and you forget to update the billing fee schedule before sending a claim.

Since so many things can go wrong, it’s wise to review every explanation of benefits closely. Make sure you can verify that the insurance claim was paid correctly.

Leave a Comment

Your email address will not be published. Required fields are marked *

Notify me of followup comments via e-mail.