By Amy Bradshaw
Verifying insurance can be tricky. One way to set your team up for success is supplying them with a step by step form or checklist that when properly filled out greatly increases the likelihood of receiving the maximum benefit the first time. Another bonus is measurability and accountability. The success of the form can be measured by the amount of initial claim submission approvals and those gathering the information can be held accountable for proper completion of the form.
This form has been evolving over many years, and during this time it has been sent to various dental claims experts for review and input. All states and insurance companies require different information so my checklist will not work for everyone everywhere however there are a few peals within the form I believe are worth the price of admission.
Accountability starts at the top of the form – date and initials of person making the call. The teammate is set up for success by having a complete list of information to gather prior to making the call. Once a representative is on the line, every question must be asked and every box marked and line written on. I suggest paying close attention to annual dental max, combined benefits, and duplicating or non-duplicating. Orthodontist and dentist may sometimes file under similar codes and this can create payment issues. Furthermore, the birthday rule is important when filling two insurances’. One of my favorite pearls takes us back to the top of the page, Call Reference Number. It has been my experience that when a dispute arises if you can present this form, filled out the same time as the recorded call with the insurance representative’s answers, the insurance company will abide by the information given over the phone.
This form is also useful when verifying insurance using providers websites. As you all know, these websites can be difficult to navigate. Add that to the typical interactions of an office setting and all of a sudden it’s nice to have a check list to refer back to. This checklist helps avoid some of the mistakes that come from distractions and interruptions during the verification process. A product of hard experience and long trial, this is one system that is profitable, measurable and creates accountability. Enjoy!