Medical & Dental Billing News

BENEFITS VERIFICATION TIP

For insurances that have a long wait on hold to speak to a representative, try calling the patient line instead of the provider line. Then, ask to be transfered to the provider extension. Your wait should be significantly decreased. Also, find out what the hours are for provider line and patient line. We have found that the patient line is opened 1 hour earlier than the provider line, giving you the opportunity to get right to a representative.

SUGGESTION WITH DUAL INSURANCE

For patients with dual insurance, in a situation where there is a dental rider on a primary medical plan, you can submit to both, primary and secondary, on the same day. This is because the secondary dental insurance has the allowance table of the primary insurance and can configure what the dental rider on the medical plan will pay. Sending both claims at the same time will decrease your time waiting for both payments. Normally, you have to wait for the primary EOB and send it in with the secondary insurance claim. In this situation, the secondary insurance does not need to see the primary EOB because they can estimate what the primary will pay. Therefore, the secondary insurance proceeds to process the claim without the primary insurance EOB.

CORRECTED CLAIM RESUBMISSION

Pearl of the day: When submitting corrected claims for procedures, make sure to put the original claim # on the corrected claim so it is not reprocessed as a duplicate. If the insurance determines a claim to be a duplicate, and does not recognize that it is a corrected claim, they pay nothing and do nothing. Therefore, all efforts, requested additional submitted information, is ignored, delaying payment. It is the insurance companie's tactic to delay payment. Ask how we know.

CRUCIAL PATIENT DEMOGRAPHICS

When asking for patient's name, make sure to ask the patient how their name is filed with the insurance company. If claim is ANY DIFFERENT i.e. how it is spelled or hyphenated they will not process the claim. Has to be exact.

BILLING XRAY-S AND FREQUENCIES

When taking a Pano and Bitewings on same day --- Insurance may give you the most comprehensive benefit applied. Which means they will give an alternate benefit of a FMX which has bitewings included. Therefore if the patient has reached their frequency on FMX limit - both the pano and the bitewings won’t be covered.

If the bitewings where submitted to insurance by themselves then they would be covered if eligible.

So if you submit to insurance a panoramic x-ray any other combination of x-rays, an alternate benefit may be given and could possibly be given the most comprehensive benefit (FMX) and no benefit will be paid, depending if the patient has reached their frequency limit on the FMX.

MEDICAID REQUEST MILLIONS FROM PROVIDERS

February 2017, Medicaid sent out letters to providers across the nation requesting refunds of money paid to billing companies that charge a % of collection for their services. Medicaid has determined that paying a % of collections is illegal fee-splitting. They are also charging 9% interest. Dental Claims Cleanup has always charged flat rate monthly fees for our services. READ THE ENTIRE ARTICLE located on our home page under pricing.