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#22 – Insurance Accuracy Report

Dental Insurance Plan Maintenance

We have several hundred insurance plans in our computer system.  We have knowledge of the benefits for a majority of them.  However, there are still lots that we have little information on.  These are the companies/policies that the insurance accuracy report focuses on.  When we know nothing about an insurance company, we are to be contacting them to update our system – this works for the new and some of the old plans.

We defaulted all our new insurance coverage tables to show $750 maximums. We chose this unusual amount to tip us off that it’s still showing up at the default and needed to have someone contact the insurance plan to confirm benefits. So, when our team ran across a plan that showed a yearly max of $750, we knew that plan needed to be contacted. We also want to follow-up with insurance plans that haven’t been updated in 2 years, as plans change.

Search the Insurance Carriers and Subscribers list for maximums of $750.

  • Check the employee’s family-file to see when the last time they were in.  If it has been more than 3 years: delete the employer and insurance.  UNLESS:  there are members of the family that are coming here currently.

Otherwise:

When we come across an insurance policy that indicates $750 for the yearly maximum, we should be contacting the insurance company to obtain the correct information for that employer.  You can request the information by speaking with a representative or have the information faxed.  We would like to find out:

  1. yearly maximum
  2. yearly deductible
  3. % of payments for preventative, basic and major treatment
  4. frequencies of exams, cleanings, x-rays
  5. sealant coverage
  6. waiting periods
  7. missing tooth clause

The insurance companies should allow you to ask for the benefits for the entire employer/group. If they don’t, then you could use the social security number of one of the employees on the list.

Calling one insurance company can give you the information of several employers, but you must ask the information for each employer separately.

The information is then updated in the Dentrix system.

Also, we need to make sure the group name and employer match on the Insurance Carriers and Subscribers list.  Find out which is correct and make the correction in the family file.

To Print Insurance Accuracy Report, follow these directions:

    1. Office Manager
    2. Reports
    3. Reference
    4. Insurance Carrier List
    5. Select or Type from/to
    6. Include Subscribers
    7. Ok
  1. Only print A-G, H-R, and T-Z, one at a time. The reports are large, so this helps in keeping the report manageable.

 

Because insurance accuracy is such a big, on-going task, we want to make sure the report is being worked as often as possible.  Yes, there will be days when it is not possible for every admin team member to fit working on the report into their day.  However, the goal for each person working should be to get 5 pages done every day that it is possible.  We need to make sure that the report does not get neglected for more than a few days at a time.

It is on the Ideal Day to make sure everyone works this report.  Keep track of the number of pages that you have updated every time you work on it, and record this information on the Ideal Day.  We also have a copy of the calendar for each month in the front of the Ideal Day – please make sure your initials and the number of pages you completed are recorded in the correct day on the calendar.

To get signed off on this task, you need to personally complete 5 pages of this report AND you need to set a system in place to maintain the dental insurance carriers in your dental software system.

_________________ Team Leader                  Date ____________________

 

Just for fun:

Match the ID letters with the insurance companies:

W__________________                    _________________DentaSelect

 

U__________________                     _________________Anthem Federal

 

XAD__________________                _________________Anthem

 

R__________________                     _________________Aetna

 

________M__________                    _________________CoreSource

 

C __________________                    _________________  Cigna

 

HPL_______________                       _________________BC/BS of Alabama

What makes Aflac different? ________________________________________________

How do we handle CareSource? ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­_________________________________________

What insurance companies are Managed Care?­­­­­­­­­­­­­­­­­­­­ 1. ____________  2._____________

  1. __________ 4. ________________ 5. ________________    6. _______________

What makes Horizon different? ­_____________________________