Dental Products Report


14 Things Insurance Companies Want Your Practice to Know

January 27, 2021
Lori Young
Lori Young

Lori Young is the Director of Payer & Strategic Relations at Vyne Dental.

These things insurance companies want your practice to know can bridge the gap between insurance payers and dental practices every day.

As a new year gets underway, you may need to strengthen your practice’s finances. The best way to do that is by starting at the source, your revenue cycle management. Finding ways to submit clean, correct claims and receive quick payments is the first step in that cycle.

There are a lot of recommendations out there about how to strengthen your finances, but one area that’s not often discussed is the viewpoint of the insurance companies. What do they suggest in support of optimizing revenue cycle management?

It’s important to understand their tips and tricks to help claims move through the process quicker. These insights can help get your claims paid faster, helping you reach your revenue cycle management goals.

Here are 14 things insurance companies want your practice to know, compiled with the help of the experts at Tesia clearinghouse who help bridge the gap between insurance payers and dental practices every day.

Claims Submission

1. ADA Claim Billing Guidelines – Make sure that your claims adhere to the American Dental Association outline for claim submission. While this may sound simple, running through that checklist can help claims get approved.

2. Benefits of EDI – It’s no secret that the future of dental is electronic claims processing. Submitting claims and attachments electronically allows insurance companies to track them and pay your office faster. The CAQH Index reports 80% electronic claim adoption among payers in 2019.

3. Know what attachments are necessary – Depending on the type of claim you are sending, adding one that doesn’t need to be there can slow down processing and subsequent payment. The same goes for not including attachments that are required for your claim.

4. Submit real-time claims – If you can utilize an electronic claims processing solution that allows for claims to be sent while a patient is still in the office, you will be able to see whether the claims are accepted or rejected right away.


5. Coordination of benefits (COB) is best received electronically – A COB is a claim where there are 2 policies at play, which could be with the same insurance company. Payers prefer to deliver benefit information electronically to your dental office as it helps to track the communication and get it in your hands faster.

Contact Methods

6. Emails vs. phone – The best way to communicate with an insurance company might not be over the phone. Contacting the payer by email allows a support ticket to be created and tracked, helping your issue get resolved in a timely manner. Make sure to use an encrypted email service to ensure any protected health information is secure.

7. Consult the website – Check the payer websites for any changes or notices to answer your question, saving you time contacting them.

8. Check your e-claims processing solution – Before contacting the payer, make sure you check your claim submission system for any notifications that might let you know a claim is rejected. It also offers solutions to help change the status from rejected to accepted.

Accurate Information

9. Sign up for direct deposit – Direct deposit is the fastest way to track and ensure you are being paid exactly what your office is owed. You can sign up for direct deposit through the insurance payer, if applicable. Or, if you use an EDI service to submit claims, your payments will be delivered as direct deposits.

10. Up-to-date Practice Management System – Check to ensure your practice management system is updated with the newest member IDs. If a claim is submitted under an old number, it is guaranteed to get rejected by the insurance payer.

11. Keep patient info up to date – Review patients’ insurance information on a regular basis to ensure all changes are updated in your practice management system. Make a habit of asking patients each time they visit if they’ve experienced any changes to their insurance information.

12. Use the current insurance payer’s mailing address – Double check the insured’s ID card for updates. This can ensure your claims are processed fast.

Policy Information

13. Make the best use of a patient’s policy – Dental insurance policies are a vehicle to discuss treatment plans with patients and what coverages are available through their plans. Having knowledgeable office staff that can discuss the options and speak intelligently on benefits, regardless of payer or plan, is an asset and instills confidence from your patients in your dental practice.

14. Treatment plans – Patients with dental insurance are much more likely to visit the dentist on a regular basis and are more compliant with treatment plans. If a patient gets regular preventative care, typically that helps avoid costly major services and it can unveil other unknown medical conditions. Encouraging regular visits not only is likely to help keep patients healthier, but it also helps maintain predictable revenue for your practice.