Benefits Verification Service

As you know, most dental plans change on the 1st of the year. The change can be anything from the frequency for exams to no longer covering crowns and anything else you can think of. In order for an office’s benefits verification to be accurate, all hygiene appointments should receive a full breakdown for the first 5 months of the year. 

$1550 eligibility on all patients in the schedule and for up to 50 full breakdowns and $10/each above the 50

$2050 eligibility on all patients in the schedule and for up to 50-100 full breakdowns and $10/each above the 100

$3200 eligibility on all patients in the schedule and for up to 100-150 full breakdowns and $10/each above the 150

$4050 eligibility on all patients in the schedule and for up to 150-200 full breakdowns and $10/each above the 200

We can do a full breakdown for all hygiene appointments in your schedule from January 1st to May 31st of the year. Starting June 1st, we will revert to doing full breakdowns on new patients and eligibility on hygiene patients as we do now. The cost will be $10 per breakdown above the base full breakdowns that you are allotted for your benefits verification fee. 

If you are thinking of choosing our service, we will look ahead to your schedule in January and estimate how many breakdowns we anticipate having to do. In order to accomplish this, we will be hiring and training additional staff and, therefore, will be charging out the estimate add-ons on 1/2/19. If we end up doing more breakdowns than estimated, we will bill the additional breakdowns as normal but if we do fewer, the over payment will be credited towards future overages for add-ons. 

1. eligibility of active coverage for all hygiene patients

2. full benefits breakdown on new patients, emergency patients, or new insurance on existing patients (ex:$1,550 for up to 50 per month, then $10/each)

3. SAME DAY ADD ONs verification with 60 minute response

4. use custom benefits verification questionnaire or our questionnaire (unique to Dental Claims Cleanup)

5. setup of insurance plan and patient's benefits breakdown in your software (unique to Dental Claims Cleanup)

6. service requires signup for ClaimX eligibility software for $18 per month

We will verify active coverage on all patients coming in for hygiene appointments to ensure they have active coverage and no plan changes with electronic eligibility or check the insurance website or call the insurance if electronic eligibility is not available. Electronic eligibility provides confirmation that the patient has active coverage and some plan breakdown of benefits. To obtain complete breakdown of plans, account specialists will call the insurance companies and record findings on a benefits verification sheet for new patients, some emergency patients, and new insurances for existing patient with new insurance. All changes are entered and corrected in the client’s patient management system. The complete breakdown, recorded on a client’s benefits verification sheet, may include custom questions specific to the client’s needs and up to 10 ADA codes or the client may choose to use DCC’s benefits verification sheet. The benefits verification sheet is designed to obtain plan specific information on frequencies, coverage on specific codes, exclusions, and limitations. We start the verification process 3 days prior to patient’s appointment. Once the schedule is verified you can still add patients to be verified and the ADD Ons will be charged at additional pricing. The same day verification cut off submission time is noon EST.

We ask that you email the Benefit Verification Form back to us with the top portion completed. We will verify the patient and respond to your email. For New Patients, Existing Patient Account New Insurance, or Emergency Patients same day verification is available with a 60 minute response window for an additional fee. The client will call DCC to notify of the rapid response verification. All emergency patients are verified with electronic services (if they came in for hygiene within 6 months) and with a phone call (if they did not come in for hygiene within 6 months and if their insurance is not linked with e-services verification). The service monthly base fee includes a based number of full benefits verification sheets per month and a charge of $10 per sheet for any benefits verification sheets exceeding the monthly maximum. DCC will be responsible for tracking and providing the client with documentation of patient names and dates of benefits verification sheets provided for the client on a monthly basis with their monthly invoice emailed to client. DCC and the account specialists are responsible to update existing patient’s accounts, setup new insurance plans, and will scan the benefits verification sheet to patient’s digital chart in client’s requested place. We will need a 2nd designated workstation so that we can be efficient with our productivity.