Family File Accuracy

Having trouble getting a claim paid? Are you even sure it was received?

The easiest way to be sure claims process and are paid with ease, the first time, is to make Family File accuracy a priority!

Typos are easy to make. Mistakes happen. Be sure you and your staff are taking their time and verifying that all entered information is accurate. Here are some common things to pay close attention to that will avoid delays and errors.

1. When entering a patients NAME, be sure first and last are right, spelled correctly and match what the current insurance plan has on file.  An accurate family file is a crucial part of the success of your practice. When this information is correct, and updated regularly, claims will be received and paid correctly.  This saves everyone time and energy and increases revenue for the practice.

2. It is imperative that the patients DATE OF BIRTH be entered correctly. One wrong number makes all the difference. 

3. Current INSURANCE coverage information must be verified on or before each visit! Who is the subscriber? The correct family member must be entered as the SUBSCRIBER, and the subscriber ID needs to be accurate. Make sure you are checking whether it is family or individual plan. Do they have a secondary? Subscriber information must be accurate for each plan. Before entering each plan, verify which is primary and secondary. 

4. Most of our plans today use electronic filing.  This feature is quick, easy and convenient. BUT- it only works when the correct PAYER ID is entered. The first time the insurance coverage is entered, the correct payer ID should also be included. When verifying coverage on or before appointments, the payor ID can very easily be confirmed as well. When having an issue with a claim, this should be one of the first things checked.

Salaries In The Dental Office - National Statistics

One of the most common questions I receive while in my travels through various dental offices is by far - "How much should I be paying my...(dental assistant, hygienist, office manager)?"

That is a very loaded question. Dental office team member salaries can vary based on experience, office location, type of dental office and so many other variables. 

Lucky for us, Dental Products Report has congregated information from the Bureau of Labor and Statistics to bring us a great resource for checking salaries.

See the report here!

Medicaid - Non-Covered Procedures

As a provider of services for the Medicaid population, there are a few requirements that you should be aware of regarding non-covered procedures. Please read the excerpt below from the Doral provider manual:

"2.02 Payment for Non-Covered Services Participating Providers shall hold Members, Doral, Plan and Agency harmless for the payment of non-Covered Services except as provided in this paragraph. Provider may bill a Member for Non-Covered Services if the Provider obtains a written waiver from the Member prior to rendering such service that indicates:

• the services to be provided;
• Doral, Plan and Agency will not pay for or be liable for said services; and
• Member will be financially liable for such services."

Please remember to obtain the patient's written waiver and signature before collecting or billing for non-covered procedures. If you need additional information on this requirement or assistance with writing your waiver documents, contact your D-TECH account representative.

DC Alliance and DC Medicaid Changes

I have great news! D-TECH has been working feverishly with Doral USA, Unison Health Plan, the DCPCA and local public health providers to enhance the benefits for the DC Alliance and DC Medicaid dental programs. Effective April 1, 2009, Unison has increased their fee schedule to participating providers and added five new procedure codes to their Adult Alliance benefit schedule. Based upon feedback from our providers, the following benefits have been added:

¨ D0330 Panoramic film

¨ D4355 Full mouth debridement

¨ D9110 Palliative treatment

¨ D9220 Deep sedation/general anesthesia – first 30 minutes

¨ D9221 Deep sedation/general anesthesia – add 15 minutes

Please note the effective date for D0330 and D9110 under the Adult Alliance program has been back dated to May 1, 2008. All previously denied claims for codes listed above are being reprocessed back to the effective dates.

Unison will also be covering Medicaid Adults(DC Healthy Smiles) effective May 1, 2009. If D-TECH is responsible for your reimbursements, we will make all of the necessary changes in your system to ensure a smooth transition. Please contact your account representative at D-TECH is you have questions about how these changes affect your office.

Onward and Upward!