5 Steps to Effective Dental Insurance Management

December 7, 2023 | 3 min read

Dental insurance management is critical to revenue cycle management (RCM), but it’s nothing close to a stroll in the park. Not only do you have to keep up with plans that vary from state to state and payer to payer. You must also ensure patient information accuracy to facilitate eligibility verification and claim submission.

How do you improve your practice’s cash flow and financial health with effective insurance management?

“By focusing on maintaining rich, updated insurance plan data, your practice is set up to minimize payment delays, maximize revenue generation, and ensure patient satisfaction. Bad habits here can grow into financial risks for DSOs as they scale.” ~ Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper.

Here’s a 5-step action plan for better data hygiene to support effective insurance management:

1. Gain the Big-Picture View

Create a list of all insurance plans and payers your practice accepts by going to the insurance or payer section in your dental practice management software (PMS). Then, use the filtering function to find all active plans.

Export the list and include fields such as insurance plan name, policy details, payer ID, and contact information. If you intend to accept other plans, add them to the list. Regularly review this list to add new plans, remove those you no longer accept, and update the details of all active plans.

2. Clean Up Your List

Identify duplicate plans on the list — they may exist due to variations in naming, minor discrepancies, or updates from the insurance carrier. Then, compare the plan details (e.g., policy number, coverage details, contact information) to determine the primary plan to retain — it should be the most accurate and/or current one. 

List all duplicate plans for consolidation and transfer all relevant information to the primary plan. Document the consolidation process and delete or deactivate the duplicate plans.

Also, review your list to identify plans or carriers your practice no longer accepts and deactivate them. If you haven’t already, notify the payers about the decision so they can change your status in their network directories. Also, let staff involved in billing, claims processing, and patient interactions know about the change.

Deactivate or archive these entries in your PMS so they’re no longer available for new claims or patient billing. Notify patients with the deactivated plans about the change. Consider creating a customized plan for these patients to encourage them to stay with your practice.

3. Ensure Accurate Setup in the PMS

Review your plan list to ensure each plan is set up correctly in your PMS. Verify features, including deductibles, maximum benefit, and coverage details. Also, check the fee schedule to confirm that it reflects each carrier’s policies and guidelines, including UCR (usual, customary, and reasonable) fees, contract rates, Medicaid fees, and DHMO fees.

If you manage a practice or DSO with multiple locations, use a cloud-based dental practice management software like tab32 to centralize revenue cycle and insurance management and ensure every office can access the latest information as soon as it’s entered into the platform.

4. Use Data Insights To Facilitate Negotiations

Collect data on past negotiations and insurance plan changes to gain insights and inform your current strategy. Then, set expiration dates for insurance plan contracts in your PMS. Create a notification system that sends an alert when one approaches its expiration date to give you ample time to renegotiate.

Also, track contract performance and stay current with market trends, changes in insurance regulations, and industry benchmarks. The insights can inform data-backed arguments during negotiations. A robust, integrated PMS like tab32 incorporates advanced dental analytics capabilities to help you seamlessly track and analyze your metrics for timely insights.

5. Set the Stage for Long-Term Success

Limit the number of key stakeholders who can view or edit plan settings in the PMS. Set user permission to grant access only to those who need the privilege to do their job. Then, develop standard operating procedures (SOPs) to outline the processes for managing plan settings.

Set an annual review schedule to evaluate plan settings access. Verify that stakeholders with access are still authorized and ensure their privilege aligns with their responsibilities. Also, review and update the SOPs to reflect changes in processes, policies, and regulations.

Ready to master revenue cycle management? Get The Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper. 

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