How Does Dental Insurance Follow-Up Accelerate Reimbursements?

You treat a patient, and your team submits a claim. And you’re relaxed, feeling that all the work has been done perfectly. Now you’re waiting for the payment to come, but weeks pass by, and you still haven’t received the payment.

Plus, a busy practice schedule doesn’t allow you the time to even remember the lost revenue.

But when you analyze your financial performance, it tells you a huge revenue loss! And you might wonder, care was perfect, claims were correct, but still, payments aren’t there, so where did the thousands of dollars go?

It’s because you missed just one step, which could have easily recovered your payments. And that was following up with payers.

Feeling worried? Well, we’re here to provide you with complete assistance on how insurance follow-up helps you maximize collections and boost revenue growth. So, let’s discuss.

What is a Dental Insurance Follow-Up Process?

Follow-up is plain simple. It’s about tracking your dental claim process after submitting it to the payer. In this process, you enter the claim number in the payer portal to check its progress or contact the payer representative to know its status.

Most practices expect that the payer automatically reimburses a claim when a claim is correct and complete. But, despite following compliance requirements, payer guidelines, and maintaining accuracy, reimbursements aren’t there.

A big reason is that they don’t invest in top-notch RCM services for dental practices. When a complete revenue cycle is managed right from the start, each step is carefully monitored, and follow-ups are a necessary part of it.

Want to know how that works? Let’s jump to the next section and explore the steps in an insurance follow-up process to maximize dental claim reimbursements.

What are the Steps in an Insurance Follow-Up Process?

Claim Submission Confirmation

Practices shouldn’t delay their dental insurance follow-ups. The process should begin right after claim submissions. Billers must contact the insurance company to confirm that the claim has been submitted and the payer has received it. The payer provides billers with a claim tracking number they can use to check whether claim processing has begun at the payer’s end.

Tracking with the Payer after 7-14 Days

In an ideal dental billing landscape, claims are reimbursed within 24-48 hours of submission. But if a claim isn’t reimbursed, it’s important to track its status promptly. So, log in to the payer portal and check the claim status by entering the claim tracking number. If it’s pending review, contact the payer and remind them that reimbursement is due.

If the payer has valid reasons, like missing documentation, don’t wait for a denial to come. Arrange all the required documents on time and provide them to the payer for review. In most cases, solid documentation solves the issue and helps speed up payments.

Verifying Claim Processing Timelines

A payer may take time to process claims. Each payer may have its own timelines for processing a claim. Some may do it within 3 business days, while some may take anywhere from 15 to 30 days to complete the process.

So, make sure to confirm the payer’s claim processing timeline first. But, still, make sure they don’t delay it further, as it becomes difficult to manage the practice’s cash flow.

Escalating Payment Delay

If claims are correct with CDT coding accuracy, complete documentation, all fields entered, and timely filing, payments shouldn’t be delayed.

But if payers exceed their claim processing timelines and don’t reimburse claims, consistently pursue insurance companies to recover payments.

Respectfully escalate the issue to an insurance claim supervisor, and if things don’t work out even after that, seek intervention from the state’s Department of Insurance. And this is a situation where most dental payers don’t want to get into. To avoid that, they’re more likely to reimburse claims.

Reconciling Reimbursement with Fee Schedule

Payers may not reimburse the full amount even after a correct billing process and a lengthy follow-up. And that’s what a practice must catch on time!

When an insurance company pays the amount, they send a dental EOB to the practice. EOB describes what the payer has covered. 

And if the payments don’t match the expected amount according to the contracted fee schedule with the payer, it becomes difficult to manage the dental revenue cycle smoothly.

So, if it’s an underpayment, send an appeal request to the payer. A copy of your fee schedule and dental EOB, each with the appeal letter that proves that you’ve been paid less than the expected reimbursement. With that, you can request the payer to pay in full and are likely to win your appeal.

What are the Best Practices in Insurance Follow-Up?

Document the Entire Follow-Up Process

Maintain a complete record of your entire follow-up, including the contact method you use for follow-up, whether via email, call, or payer portal. You also mention the insurance company name, payer representative name, date and time of each conversation with the representative, and brief notes on your discussion.

This record is your legal protection, supporting your case if you escalate the issue or if there is a legal dispute.

Prioritize High-Value and Aging Claims

If multiple dental claims are in pending status, check which claim is of higher value and can have a better financial impact on your practice revenue. Fresh claims with a higher dollar amount can help you maximize collections and profitability.

But that doesn’t mean you should ignore aging claims. With smart A/R management services, you can easily recover your payments fast. A/R experts strategize recovery efforts according to the type and date of the claim, and make sure that you’re paid fast for the dental services rendered.

Outreach the Payer Consistently

Whether it is through payer portals, phone calls, or electronic claim-tracking systems, every outstanding claim needs a touchpoint. Follow up on aging claims every 14 days, not quarterly. Payers respond to persistence, and documented outreach creates an audit trail that protects your practice.

Automate Follow-Up Reminders

Insurance follow-up is effective only if you monitor the claim and check with the payer on time. If you miss it, recovery may not be very effective. But, with excessive workload, the practice staff is likely to forget that.

However, if you automate follow-up reminders in your practice management system, it notifies you after:

• 14 days for the first follow-up
• 21 days for the second follow-up
• 30-45 days for the third attempt

Timely notifications help you follow up promptly.

Outsource the Follow-Up Process

Following up with insurance companies isn’t an easy task. It requires time, dedication, and expertise to coordinate with dental payers and make sure that the pending claims are reimbursed.

And when you’re running a busy dental practice, doing multiple tasks like scheduling appointments for patients, managing patient care, and planning treatments, you can’t allocate time to follow up on outstanding claims. This is where outsourcing companies, like TransDental, provide support.

They manage all of your front-end, mid-cycle, and back-end revenue cycle processes, including follow-ups with dental insurance companies on your behalf. With outsourcing support, you can easily recover your due payments. You’re relieved of the hectic follow-up process and fully dedicate yourself to providing quality patient care, while outsourcing partners handle that for you.

Conclusion

Most practices give up on dental insurance follow-up because it’s a very lengthy process, and they don’t have the time and bandwidth for it. But if you implement follow-up for outstanding claims, you can recover much of your revenue. All you need is to follow up at the right time, within a week or two after claim submission, instead of waiting for the payer to reimburse. Put efforts into high-value and aging claims, but also keep tracking recent claims to prevent their aging and speed up reimbursement.

Frequently Asked Questions (FAQs)