PPO Optimization

Helping you maximize every hour you spend practicing.

PPO Optimization is the process of balancing PPO reimbursement with access to patients with dental benefits.  Patients with dental benefits are more likely to see oral care and to follow their treatment plan.

Dentists are participating in more PPO networks than ever before.  At the same time, payers are using more and more networks at the same time.  For example, a common national payer has its direct network as well as leases 7 other networks.  A dentist that participates in one of those networks will participate in an average of 4.62 of those networks.  That gives the payer multiple price points to find the lowest and they only have that advantage through poor PPO participation decisions.

That leaves two choices:

  • Those that do not optimize will experience continued increase increased reimbursement pressure as payers get better at using the lowest available fees for each practice. These practices will experience an increased PPO discount of 2% to 4% over the next several years.
  • The typical practice that optimizes will increase their PPO revenue by $30K to $50K per year and maintain higher than market increases in the future.
Busy dental office manager

Our Optimization Process

Filing dental insurance claims

Step 1

PPO Optimization is specific to each practice based on individual objectives, local PPO fees, and available members with benefits.

Our experts will:

  • Develop and make recommendations on charge master (UCR Fees) based on:
  • Market rate for services in your zip code and recommended fees
  • Competition - how many dentists are available in your area and which PPO networks they participate in
  • Inventory - what PPO networks is your practice participating in:
  • Direct or through a leased network relationship
  • Current fees
  • Are the practice's fees eligible for renegotiation

Step 2

Our experts will:

  • Develop and recommend a strategy specific to your practice and objectives, including:
  • PPO networks to join
  • PPO networks to terminate
  • Negotiate fees where available

For practices using Dentalogic’s Insurance Billing service, our team will ensure each PPO fee schedule is accurately updated in your practice management software.

This helps your practice collect the correct amount from your patients at the time of service.

Narrative and attachment for dental insurance claim
Dental billing claims follow-up

Step 3

Ongoing Support

Payers are continuing to make changes in the number of PPO networks used, as well as the order in which they are applied. For Dentalogic Insurance Billing clients, our team monitors your practices payments to identify those changes and make recommendations as necessary.

For Non-Billing clients, our team will monitor changes we are seeing that may affect your practice’s strategy and make recommendations as necessary. Your practice is continually receiving solicitations to join additional PPO networks. One wrong decision can completely negate all our efforts.  

  • For example, joining a network with a deep discount to help a few patients or to fill chair time is a common mistake. If that network is used by other payers, it will erode the reimbursement from patients that you already have.

It’s an expensive mistake from the best intentions.

Step 4

Network Research

Each time your practice receives a solicitation, our team will research the network and make recommendations based on:

  • Which other payers lease that network?
  • What is the potential impact for current patients?
  • What are the benefits from joining?
  • How many potential members?
  • What are the plans?
  • Benefit Level
  • Benefit Steerage (does the plan have greater benefits in-network resulting in more pressure for patients to see a network dentist?)
  • What is the out-of-network reimbursement?
Dental insurance appeal letters
Posting dental insurance payment

Step 5

Make informed decisions on your PPO participation and fees.

Sit back back and relax. We have you covered!

Pricing Summary

A pricing structure you can understand.

Our approach is simple. Our experts will help your practice achieve and maintain PPO Optimization for a flat monthly fee.

Dentalogic Billing Clients ........................$499/month
Non-Dentalogic Billing Clients ....................$999/month

There are no time requirements, and your practice can quit at any time. We keep our clients by delivering results for them every day!

If you'd like to learn more about our Insurance Billing Service, click here.

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Reach out to us today to see how we can make your day just a little bit easier.

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