7 Ways to Streamline Dental Insurance Claims Processing

by James De Roche

Processing dental insurance claims can be a complex and confusing task. But if you can identify your bottlenecks and redundancies while automating certain manual tasks, you can speed up claims processing and reduce costs.

Unfortunately, this can be challenging if you don’t know where to start. But with the right software and best practices, you improve your dental insurance claims process drastically. 

Follow these 7 steps to streamline dental claims processing in your clinic.

1. Map Out Your Dental Insurance Claims Processing Workflow

Processing dental insurance claims involve a lot of administrative steps alongside patient management. 

Before you can improve any process, you need to map out the workflow. This helps you identify all the steps in your processes. As a result, you can spot redundancies, inefficiencies, and bottlenecks. And you can build solutions that increase productivity in your dental practice.

Dental Insurance Claims Process

  1. Billing: Your dental practice sends a bill to the insurance company.
  2. Adjudication: The insurance company’s certified claims processor will review the claim, compare it to the patient’s insurance plan, and validate it.
  3. Reconciliation: If the claim is covered by benefits, the insurance company pays it. This may happen in full, or, depending on the plan, might be partially billed to the patient.
  4. Validation: The amounts paid out will be applied to the plan’s deductible and max-out-of-pocket totals.
  5. Explanation of Benefits (EoB): The EoB details the list of services given, how much insurance is covered, how much the provider paid, and what remains to be billed. This is given to the patient.
  6. Final Billing: If insurance doesn’t cover all the services, the final bill is sent to the patient for payment.
  7. Payment: The final step is when the patient pays the claim. Ideally, patients should always double-check the EOB to see if it’s accurate. Claims may be updated and fixed without penalty.

How you map out this workflow depends on how you run your dental practice and its workplace culture. You can whiteboard it out, use sticky notes, write it out in a notebook, or use workflow mapping software. 

What matters most is that you clearly define each stage of the process as accurately as possible. Once you see the process, you can find improvements.

2. Identify Inefficiencies in Your Dental Claims Process

Once you’ve mapped out your workflows for dental insurance claims processing, you need to look for your costly slowdowns. Are there any extra steps in the process? What steps can you eliminate? What’s missing? Dive into your claims process and question everything.

It’s important to work with your administrative team on this. They’re directly involved in the dental claims process, so their input is extremely valuable. Get their insights. And ask them what they think the optimal version of this process would look like.

3. Use Electronic Forms to Collect Patient Data

Collect patient data using a detailed, electronic form. This allows you to quickly get all the important info you need to file dental claims in one secure location. 

Electronic forms can collect information like the policy holder’s name, social security number, employer’s details, etc. And they submit those details into a secure dental practice management solution that will keep patient data organized.

This way, you don’t have to go hunting down paper forms in a filing cabinet when processing dental insurance claims. 

4. Reduce Data Entry Errors

Dental insurance claim errors are extremely time-consuming to fix and they put your business at unnecessary risk. At best, the claim gets rejected and your team has to waste time refiling the claim. Worse, it can leave your dental clinic on the hook to cover costs.

And that’s not all. 

Dental claim errors upset patients, which can damage relationships, lead to negative reviews, and harm the workplace culture of your dental practice.

To avoid dental claim errors, you need systems in place to reduce the likelihood that errors may occur. Leveraging automation and integration can help streamline processes, reducing errors. 

Every time a person touches a process, there’s a chance that an error can occur. Instead, if you capture patient data electronically and match it to the right treatment before reviewing the claim, you can increase your claim accuracy rates.

5. Make Sure Each Claim Goes to the Right Place

Sending a claim to the wrong location is a headache. It makes dental insurance claims processing more time-consuming and frustrating for your office. 

You don’t want to spend time resubmitting a claim because you mixed up envelopes.…

Rather than double- or triple-check each claim to ensure you’re sending your claim to the right place, leverage dental practice management software to automate the process.

Once you have the correct patient data, you can verify it and send the claims out quickly through your system. This prevents you from having to print, scan, sign, and mail claims.

6. Create Templates for Clinical Notes

An easy way to make things difficult when it comes to getting your claims paid is keeping poor clinical notes. The more data you can accurately collect on each patient, the easier your claims filing process will be. 

Rather than let each dentist track clinical notes using their method (or worse, by writing them out manually), use templates for clinical notes.

By creating a template, you ensure each practitioner takes notes the same way, collecting the right information every time. As a result, you’ll have everything you need to file a claim correctly each time.

7. Always Submit Proper Imaging with Claims

If you don’t send in the proper photos, charting, or films, you risk a potential headache with your dental insurance claims processing. Your claim may get rejected. Or, only part of the claim may be processed. 

Instead, send in all imaging for X-rays for scaling and root planing, implants, and crowns, as well as pre and post-root canal images. 

Make sure everything is properly mounted, readable, and up-to-date. That way, the dental insurance company can process your claim faster.

About the Author

James De Roche is a technical writer with a background in process improvement, workflow automation, and low code platforms. He regularly writes in the dental and software niches, looking for ways to help businesses streamline results.