Electronic check
The eligibility request returns the skeleton: coverage status, annual maximum, deductible and class percentages.
Dental insurance verification that doesn't stop at “active”
Software that calls the payer.
Frequencies, waiting periods, downgrades, remaining maximum, and the date each service was last paid. The system runs the eligibility check, reads the portal, places the payer call and sits through the hold, then writes every field into your own verification form. Nobody on your team touches a phone.
Somebody in your office is on hold right now.
These are practice staff describing the job, in public, in their own words. None of it is unusual and all of it is billable time.
“If you have to spend hours a day on the phone on hold waiting for Delta, it's kind of mind numbing.”
A practice administrator, describing the verification day“Most claims are very simple to submit. Insurance verification and copay estimates take a lot more of your time.”
Said by someone arguing against outsourcing billing“We couldn't find anyone to hire with dental insurance experience, so we are muddling along.”
An office manager after a failed hireThe electronic check answers five questions and stops.
Real-time eligibility is a screening tool. It tells you a plan exists. It does not tell you whether this patient has already used the benefit you are about to schedule, and that is the part that comes back as a denial.
What an eligibility check returns
5 fields- Coverage active or inactive
- Plan effective dates
- Annual maximum
- Deductible
- Coverage percentage by class
Response ends here. Everything below this line has to come from a payer portal or a phone call, which is why your coordinator is making one.
What comes back
Those five, and these- Annual maximum already used, and the dollars remaining
- Prophylaxis frequency, and the date it was last paid
- Bitewings frequency, and the date they were last paid
- Perio maintenance history and its interval
- Waiting period remaining, per class of service
- Missing tooth clause, and which teeth it excludes
- Posterior composite downgrades, with the code it pays at
- Crown and bridge replacement clause
- Age limits on sealants, fluoride and orthodontics
- Exam frequency, and the last date on file
- A code-level breakdown for the procedure you have scheduled
- Which fields came from the payer by phone, and which came electronically
Four steps. The third one is worth the most.
The electronic check and the portal take seconds and every vendor does them. The phone call is where the fields that come back as denials live, which is what makes it worth the most. It is the step most vendors leave to your staff.
Portal lookup
The payer portal is read for what the electronic response omits: frequencies, service dates, remaining benefit.
The payer call
Where the payer publishes nothing, the system calls and sits through the hold. Nobody at your desk waits.
Back into your form
Everything lands in the form your team already uses, each field marked by where it came from.
Run the software for a week without moving anything.
Your coordinator keeps doing the verifications exactly as they do now. The software runs the same ones in parallel, and at the end of the week you put the two side by side. Nothing in your schedule depends on it being right, which is the point.
- You send the patients you are verifying anyway: member ID, date of birth, carrier, planned procedure.
- You get back a full breakdown on each one, in your form.
- You compare them against your own. If it missed things, you have lost nothing but an email.
Start the week
Six fields. The agreement comes back the same day, and the week starts whenever you say.
There is a problem
That is in. You will get the business associate agreement from
[email protected] today, and nothing else until you send it back.
You have probably already tried outsourcing this.
The category is old, the large players were bought by the distributors, and the complaint practices make about them is consistent enough to be worth quoting.
The same outsourced feel, with communication issues and limited results.A practice manager on the incumbent verification services, in a public dental forum
What the complaint usually is
- The breakdown comes back the next day, after the patient has been scheduled
- It answers coverage but not frequency, so the hygiene appointment still gets denied
- A different person each time, none of whom knows your plans
- Priced on a percentage of collections, so it scales with your success rather than the work
What is different here
- The deep fields are the product, not an upgrade tier
- Every field is marked with where it came from, so you can see what was verified and how
- A flat monthly plan sized to your volume. Not a cut of your collections and not per seat
- The same system on every call, set up once with your plans and your form
Your patient data stays in the US. Nothing moves before the agreement.
The first question every office asks is where the data goes. The answer is short: US servers, a US phone line, and a business associate agreement signed before you send a single name. It is the same one-page agreement you have signed with every vendor that touches a chart.
Nothing offshore
Servers in the US, the payer call placed from a US line, records encrypted at rest. No overseas team reads a chart and nothing leaves the country at any step.
Signed before the first name
The agreement goes out before you send a single patient. Read it, sign it, or decide against the week. Nothing has moved either way, and it has cost you nothing.
No agreement, no call
The system will not place a call naming a patient unless the agreement is on file. A person checks the paperwork and turns it on. It is not a default setting.
Questions people ask first.
What does it cost after the free week?
A flat monthly plan per practice, sized to how many verifications you run. The quote comes after you have seen a week of the work rather than before, because the number means nothing until you know what is coming back.
It is not a percentage of collections and it is not per seat.
What do you need from us to start?
A signed business associate agreement, your NPI and your tax ID. The payer asks for the last two to authenticate the caller as the provider, so there is no route around them.
Then, per patient: member ID, date of birth, carrier and the planned procedure. The same details your coordinator already gathers before picking up the phone.
Does it work with our practice management software?
Whatever you run. Dentrix, Eaglesoft, Open Dental, Curve, Denticon, Carestream and the rest: the breakdown comes back in your own verification form, filled, in the layout your team already reads. Send a blank copy of it and that is what comes back.
How long does one verification take?
Where the electronic check and the portal answer everything, minutes. Where a payer has to be called, it takes as long as that payer's hold queue takes, and some of them are genuinely long.
The difference is that the system does the waiting. Your coordinator's morning is not the thing being spent.