By ADMC Member Chris Haines
While managing claims, every office manager dreads to hear the word that strikes fear in the hearts of both managers and patients alike: “Denied.” Did you know that there are systems in place that could make your practice experience fewer denials and a faster turnaround time on claims?
How about streamlining your practice against embezzlement? According to the American Dental Association survey, 35% of dental practices have been embezzled once and 17% more than once, so nobody is immune to the ugly truth.
One of the most clear cut methods to protect your practice is the employing of Electronic Funds Transfer ( EFT) methods into your internal systems. EFT is a system of transferring money from the Dental Insurance Company electronically to a provider without any paper checks changing hands with a trace number attached to automatically re-associate the (ERA) electronic remittance information.
So what exactly is an ERA you might ask? ERA, or Electronic Remittance Advice, is an electronic version of a paper Explanation of Benefits (EOB), with all the same information. This is an electronic communication between the insurance company and the provider’s office.
The Electronic Remittance Advice (ERA) information needs to be filled out also stating the clearinghouse of where you want the ERA delivered in order to re-associate the trace number on the ERA with what’s been deposited in the bank by the insurance company.
Explanation of Benefits (EOB) Form
Below is an example of an EOB form. *Patient information removed for confidentiality:
The top of the (EOB) Explanation of Benefits Form contains:
Insurance Contact Information
Helpful information if you need to contact the insurance company to get a clarification, ask a question, or resubmit an attachment on a claim.
- The Name of the patient’s insurance company.
- The Claims Department Address for where to mail claims directly.
- The Payers Claim Office Contact Information, including fax and phone.
Patient or Subscriber Information
Accurate information regarding the patient is vital to the claims process. Make sure to fill out all necessary forms about the patient.
- The Patient’s (Member’s) Name.
- The Subscriber ID Number (unique to each patient).
- The Name of the Patient’s Provider.
The insurance company uses ADA codes to tie reimbursement to procedures.
- The Tracking Number for the Claim
- The Date the Claim was Received.
- The Claim Status (The claim status will say processed as Primary, indicating that the patient is the policy holder).
How much was paid out for the claim? What does the patient owe and how much did their insurance plan cover?
- The Payment Amount: This is how much the claim paid out, or “covered.”
- The Patient’s Responsibility: Often referred to as co-pay, or what the patient owes that the claim did not cover.
- Claim Amount: How much the claim is willing to pay.
- Claim Date: Date the claim was made, or date of service(s) rendered.
- Payment Date: Date that the claim was paid out after processing.
- ACH Number:( Automated clearinghouse) that is the same as a trace number.
- Payer Trace Number: A reference number given to each ACH transfer and can be used to locate the ERA.
- Handling: This line is for remittance info only.
At the bottom, the form will contain a table with the organized procedures and amounts owed:
- One column will contain the Service Date (the actual date service was rendered).
- Another column will contain the Procedural Code (code needed which matches the procedure rendered for insurance clarification purposes).
- The following columns contain the Charge Amount (or amount the patient was charged)
- The Adjusted Total (What the patient owes after claim is paid out).
- The Payment Amount (How much the claim paid).
- Note: Every patient’s insurance is unique. Some cover x-rays at 100% and others cover 70% based on how their plan is designed. For example, if the plan is not covered at 100% then the patient is responsible for the entire balance unless the provider is in network.
If you still have questions and would like to schedule a no obligation phone call with me please follow the link to my calendar here: https://calendly.com/dentalwebsmart
If you would like to work at your own pace independently you can access my Ecourse on Getting Paid Faster with Electronic Funds Transfer (available for your whole office team!) follow the link here: https://app.dentalwebsmart.com/courses/1
This article is contributed by ADMC Member Chris Haines
With 34 years of experience her education, practice management and clinical skills have allowed Chris Haines to provide a modernized technology to her consulting services with a strong foundation in the practices insurance systems by using EFT & ERA technology. Learn more