Don't just send it and forget it

I hope you have enjoyed reading all my good tips and tricks on dental insurance over the past few weeks. Insurance is such big issue in most dental practices that I feel it is worth talking about … even if it is not the most exciting topic. There is another piece of managing dental insurance that I want to discuss today and that is managing your pre-estimates. I don’t know if it is because of the economy or if insurance companies are mandating preauthorization’s more these days, but I am noticing more and more offices sending in pre-estimates for treatment. Many of you already know how to send out a pre-estimate for treatment … but don’t just stop there and think that you are finished. Here’s a checklist for better managing your patients’ dental pre-estimates.

 

• Create and send the pre-estimate claim form from the patient’s ledger. From the ledger, click on the Treatment Plan page by selecting Options > Treatment Plan. You can define the color of this page so it’s not confused with the actual ledger page. To change the color of this page, go to File > Ledger Colors Setup > then choose your personal color scheme. Once you are on the Treatment Plan page, if the patient has treatment planned procedures on this page, you can simply select the line items and click on the insurance icon to batch the pre-estimate. If there are no treatment planned procedures you can add them from this page by clicking on Transaction > Enter Procedure.  Now you can attach any electronic X-ray or image and also document the clinical narrative in the Remarks for Unusual Service box and this pre-estimate is ready to go out with your next batch of eClaims.

• Just like you would follow up on unpaid insurance claims, I would suggest checking on unprocessed pre-estimates exactly the same way. Go to your Office Manager > Reports > Ledger > Pre-Treatment Estimate Aging Report. Filling your doctor’s schedule might depend on making sure these pre-estimates are being received in a timely manner. (insert image)

• When the Pre-Treatment EOB is sent to your office showing the itemized approval of the procedures, you will want to enter the pre-estimate just like you would a payment on an actual claim. Go to the Ledger > Options > Treatment Plan to switch to the Treatment Plan page (or you can click on the TX icon on the toolbar). Double-click on the claim form and click on Enter Estimate. Now you can itemize each procedure and what the insurance company is going to pay on each line item and document the reference number for this pre-estimate. It is important to receive your pre-estimates just like an actual claim because it will give you a more accurate out-of-pocket for your patient. Remember, it clears it off the aging report and closes it on the ledger.

• If you have finished this last step, the patient has completed the treatment, and you are now creating an actual insurance claim, it will automatically insert the Pre-Treatment Estimate reference number onto the actual claim so you don’t have to look it up. Pretty slick, huh?

I hope this little nugget of information will help you better manage your patient’s treatment plans and pre-treatment estimates and keep your doctor’s schedule full and productive.