Protect Your Revenue Cycle by Building an Insurance Claim Process

Jacob Corlyon


As the industry begins reopening practices, it’s imperative for dentists to think about how they can build their practice revenue. One way to take control of the accounts receivable (AR) cycle is by creating a better insurance claim process. 

Once routine and elective care appointments resume, insurance providers are likely to be overburdened. If practice staff isn’t diligently managing claims, they can get lost in the clutter. 

Evaluate the way your office has been handling claims and look for opportunities to make improvements. Creating a streamlined approach to your claim processing can help maximize efficiency and increase payouts, while at the same time improve both the patient and administrative experience. A 60-day process is a good place for most practices to start:

Day 1: Submit insurance claims. Make sure all patient and service details are complete and accurate. Check that all necessary X-rays, charts, or other attachments are included with the claim. 

Day 15: Check the status of submitted claims from the past two weeks. If any have reached 15 days without payment, make initial contact with the insurance company. Confirm its receipt of your claim and request an estimated payment date. If the company said it didn’t receive anything, then resubmit as necessary and confirm receipt immediately. If a claim is denied, find out why and see what further documentation you can provide. Make note of all communications in the patient files. 

Day 30: Time for another look back. Check for any unpaid claims from the past 30 days and make sure the 15-day claims have been processed. If anything is outstanding, follow up with the insurance company again to check the status of payment and see if it needs additional information. Inform the patient as necessary to their outstanding balance, noting dates of insurance claim submission and follow-up.  

Day 60: At this point, you are two months out for payment of services. Usually there’s a reason claims haven’t been paid by day 60, and you should look at doing a block resubmission to get those back in the queue and part of your new insurance AR review system. 

Daily: There are two important factors that should be handled daily. First, deposits. You need to keep your cash position up, so make sure you’re depositing remittances as they are received. Especially as you are trying to recoup revenue from the shutdown, making deposits every day is more important than ever. Second, submit new claims to insurance providers daily.

Once you have a process in place, the importance of communication cannot be overstated. Ensure that your staff understands the steps to filing claims and following up on payment status.

Have staff communicate the billing process to patients prior to their appointments so they understand how your office works with their insurance provider and what might be expected from them should there be any payment issues.

And, encourage staff to build positive relationships with insurance companies they work with regularly. Creating clarity will reduce the chances of misunderstanding and missteps, which only prolong you getting paid.

As you dive into an insurance AR review, fix any problem areas you find by creating a formal process. This will help you minimize errors, streamline administrative work, and help you get paid in a more efficient and organized manner.

Your office can’t provide the best care for patients if it’s not financially stable, so establish measures to collect insurance payments as quickly as possible.    

Mr. Corlyon is CEO of Capital Collection Management, which provides revenue cycle consultation and collection services for the dental industry.

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