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Dental insurance verification: here is the information you must have

Don’t hold up dental insurance revenue by missing important patient and insurance demographics

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When it comes to dental insurance verification, having the right patient data at hand is paramount for ensuring patient safety, clean claims submission, and efficient processing. Here, we quickly, and directly outline the key patient demographic information required, outside of detailed health history, for new patient appointments in 3 sections.  

Review your patient intake forms, and new patient call scripts and ensure the following is captured for a clean dental insurance revenue cycle:

  1. Patient Information:

  • Name: Providing the patient's full legal name is essential for accurate record-keeping and insurance verification.
  • Date of Birth (DOB): Birthdate ensures proper identification and eligibility confirmation.
  • Social Security Number (SSN):  Although not always mandatory, ssn’s can aid in unique identification and may be used as a member ID in insurance verification.
  • Address: the patient's current address is crucial not only for correspondence and billing purposes, but also processing claims. 
  • Phone Number: Contact number(s) to reach the patient for appointment reminders, inquiries, and emergencies.
  • Email Address: Email serves as an additional communication channel for appointment reminders and notifications.
  • Emergency Contact Name: In case of emergencies during dental procedures, an emergency contact is vital.
  • Emergency Contact Relationship: Understanding the relationship helps in contacting the right person in emergencies.
  • Emergency Contact Phone Number: Contact number of the designated emergency contact.
  • Date of Last Dental Visit/Exam: This information not only aids in assessing the patient's oral health history and planning subsequent treatments, it also helps to know if the patient’s insurance frequency limitations have or have not been met.

  1. Primary Dental Insurance Information

For efficient insurance verification, detailed information regarding the primary dental insurance is indispensable:

Subscriber Information: (ALWAYS ask the patient if they are the policy holder)

  • Name: Full name of the subscriber listed on the insurance policy if it is not the patient.
  • Date of Birth (DOB): Birthdate of the subscriber for verification purposes.
  • Address: Subscriber's current address for correspondence and verification.
  • Employer Associated with Plan: Information about the employer associated with the dental plan, and can help determine group numbers if needed.
  • Relationship to Patient: Clarification on the relationship between the subscriber and the patient (e.g., self, spouse, parent)
  • Insurance Company: Name of the insurance company providing coverage.
  • Member ID: Unique identification number for the subscriber. Keep in mind: This may or may not be the subscribers SSN.
  • Group Number: Group identification number associated with the dental plan.
  • Mailing Address for Claims: Address where claims should be sent for processing.
  • Provider Phone Number: Contact number for the insurance provider for inquiries and verification purposes.

  1. Secondary Dental Insurance Information

Ask if there is additional coverage - and if the answer is yes, repeat section 2 for this plan and be sure to follow coordination of benefits rules when you enter the plan(s) into your practice management software. Claims will not process accurately if you list a dependent as a policy holder. 

By ensuring that this data is collected accurately and completely, dental practices can streamline the insurance verification process, minimize errors, and enhance patient care experiences. Effective communication with patients regarding the importance of providing such information can contribute significantly to the efficiency of dental administrative processes. Always get copies of the front and back of insurance cards if your patient has them available to ensure accuracy of information - especially if you obtained it by phone.

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