How to Make Dental Insurance Verification Less Time-Consuming

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Are you still filling out an Insurance Verification Form for each patient?

What if there was a better way to compile and save insurance plan details in your practice management software?  

Over the past two years, Dentalogic has been working with practices across the country handling dental insurance verification. This has given us a peek into the many ways that the insurance verification process is handled. The most common method that we have seen is the standard insurance verification form (“IVF”) being filled out by hand for each patient, scanned in, and uploaded to the patient's individual document manager in your practice management software (“PMS”). This process is very time-consuming and often cannot be completed for every patient.  

To understand why this process is flawed, and how to improve it – let’s dive in to how your software formats and stores insurance plans.  

Most dental PMS’ have seven core modules: appointment/schedule, patient/family module, accounting ledger, treatment planner, insurance module, document/images manager, and manager/reporting module.  

Insurance plans fall under the "insurance module" and are meant to be used as a “practice-wide” record of each particular insurance plan. Your PMS allows you to store this data without reference to any specific patient’s information.  

Why is this important?  

An insurance plan itself does not differ from patient-to-patient. The coverage details are the same for every patient enrolled under a particular group number. Yes, a group may have a “High Option” and a “Low Option,” so these would just be added to your software under two separate insurance plans noting “High” and “Low” in the group name. Some individual or school district ISD policies also offer "progressive plans," these plans change from year-to-year depending on how long the subscriber has been enrolled. The best practice for building in progressive plans is build these plans in separately, and put a label in the group name for "Year 1", Year 2", "Year 3", etc.

Insurance Plan Information vs Patient Insurance Information

There are two separate aspects to consider when verifying dental insurance benefits; the standard benefits by which the plan operates, and the patient-specific details related to their insurance plan.

Let’s take a look at what I mean by this.

Plan-Specific Information – This information is standard for each plan and does not change depending on the patient.  
  • Carrier Name, Claims Address, Phone Number, and Payor ID
  • Group Number and Group Name
  • Waiting Period, Calendar Year/Policy Year, Beginning Month, Network Status/Fee Schedule
  • Individual/Family Deductible and Annual Maximum
  • Waiting Period ("WP") - (The waiting period is typically a standard amount of time, regardless of the patient. See "Effective Date" below to see how to calculate if a WP has been satisfied.)
  • Missing Tooth Clause (“MTC”) - (Sometimes there will be certain parameters outlining when the MTC will be applied. For example: some policies will not apply the MTC if the tooth was extracted while covered under a previous policy, or the MTC only applies if the patient has an effective date before 01/01/2022. These are still plan-specific guidelines, even though they can impact patients differently depending on their patient-specific details.)
  • Co-Insurance Percentages, Frequencies, Downgrades
  • Age Limitations, Tooth Restrictions, Code-Specific Guidelines
  • Ortho Co-Insurance, Age Requirements, Lifetime Maximum, Payment Terms, Initial Payment Amount
Patient-Specific Details – This information covers how the patient’s coverage interacts with the standard insurance plan breakdown.  
  • Member ID
  • Effective Date - (If you know the plan has a waiting period, you can use the effective date to determine if the waiting period or missing tooth clause has been satisfied.)
  • Remaining Individual and Family Deductible, Remaining Maximum
  • Treatment History - (Using treatment history, you can determine if the patient is eligible for a particular service by referencing the plan frequencies in your Plan Notes.)

Plan Notes vs Insurance Verification Form

Completing an insurance verification form for each patient is a long and inefficient process. As stated above, plan information should only be gathered once per year, for each insurance plan. This information should be added as text notes should be added to the Insurance Plan module, rather than uploaded as a PDF to the patient’s document manager. Once the plan is built in once, all you need to do is attach that plan to each patient that is enrolled under that group and your notes are already copied over to each patient. Separating Plan Information from Patient Information is the key to improving the efficiency of your insurance verification process.

How much quicker would it be to just have to gather the patient-specific details, rather than a complete IVF breakdown for every patient?

For an example of what Dentalogic's Insurance Plan Notes contains, see the Example PDF below:

If you decide that you would rather outsource your dental insurance verification, we can help with that too! Just fill out our Get Started form and we will be in touch!

Kinzie Broxson
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