Wednesday, August 5, 2020

Verifying Patient Insurance Information


How often do you verify patients’ insurance benefits in your practice? If you want to provide patients with the most accurate estimates, it’s important to know what their insurance will pay for a specific procedure. I recommend that you verify a patient’s benefits at least every six months. It’s quick and easy to verify insurance benefits by using the eCentral Insurance Manager. You can access the eCentral Insurance Manager from the patient’s Family File by clicking the “E” icon. Once you have entered the patient’s information, you can find general benefit information such as maximums, deductibles, and coinsurance amounts. 

When you initially verify insurance benefits for a patient, there are many important details you should look for in their benefits. For example, is there a missing tooth exclusion? What is the replacement period for crowns and prosthetics? 

You can use the insurance plan note in the coverage table to document this type of information. Maximums, deductibles, and co-insurance amounts can all be entered into the coverage table and will be used to calculate insurance estimates. You can also copy the benefit information from the eCentral Insurance Manager directly into the patient’s Document Center in Dentrix. When something is added to the patient’s Document Center, it is automatically labeled with today’s date. You can refer back to that date in order to see the date the benefits were last verified. 

Once you have the insurance benefits entered initially, the information will need to be updated regularly. I suggest reviewing the patients who are coming in for an appointment the next day. Check the patient’s Document Center for the date of the last insurance verification. If it has been six months or more, reverify the benefits. 

When reverifying insurance benefits, here are some important things to look for:

  • How much of the insurance maximum has been used?
  • Has the deductible been met?
  • Has the patient met his or her frequency limitation for an exam or a prophy?
By obtaining this information, it will help you to collect patients’ out-of-pocket expenses more accurately.

If you are an out-of-network provider for a patient’s insurance, it can be helpful to know what the insurance usual and customary charge is for common procedures. This will help you to provide patients with more accurate estimates. A few insurance companies will provide you with that information over the phone. The information can then be entered into the insurance plan’s payment table. 

The payment table can also be updated whenever you post an insurance payment for a claim. I highly recommend updating the payment table, because the payment table applies to all patients in Dentrix that are covered under that particular insurance plan. The only time I advise offices not to update the payment table is if a procedure is denied or pays less for a reason specific to a particular patient. For example, if a prophy isn’t covered because a patient has exceeded their frequency limit, I would not update the payment table. 

Verifying patent’s insurance benefits frequently helps your office to provide your patients with more accurate insurance estimates and keep your records up to date. Using eCentral Insurance Manager makes the process quick and easy. If you have questions on this topic, please e-mail me at vectordentalconsulting@gmail.com.


Charlotte Skaggs, Certified Dentrix Trainer

Charlotte Skaggs is the founder of Vector Dental Consulting LLC, a practice management firm focused on taking offices to the next level. Charlotte co-owned and managed a successful dental practice with her husband for 17 years. She has a unique approach to consulting based on the perspective of a practice owner. Charlotte has been using Dentrix for almost 20 years and is a certified Dentrix trainer. Contact Charlotte at vectordentalconsulting@gmail.com.

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