We submit insurance claims, post the payments that come back, work the denials, and follow up on claims that have not been paid. The same team handles all four parts.
After a dentist treats a patient, the practice has to ask the patient's insurance company to pay its share. The practice does that by sending a claim. The insurance company either pays the claim, denies it, or pays less than expected.
When a payment comes in, it has to be posted against the right patient and procedure in the practice management software, with PPO write-offs adjusted to the contracted fee schedule. When a claim is denied, someone has to read the explanation of benefits, figure out why, and decide whether to correct and resubmit, file an appeal, or accept the denial. When a claim sits unpaid, someone has to chase the carrier.
That whole loop is what insurance billing is. It is the work of submitting claims, posting payments, working denials, and following up on aging.
We run that loop for your practice. Claims go out to the carriers. Payments get posted with the right write-offs and primary or secondary splits. Denials get pulled and worked. Aged claims get followed up on.
The same team handles all four parts of the loop. There is no handoff between a submissions person, a posting person, and a denials person on your account.
We submit claims to the carriers with the attachments and narratives those carriers need. Some procedures have specific documentation requirements, like pre-op X-rays for crowns or periodontal charting for SRP. Those go in with the original submission rather than being added later after a denial.
When the EOB comes back, we post the payment to the right patient and the right procedure in your practice management software. PPO write-offs are adjusted to the contracted fee schedule. When a payment splits between primary and secondary, the split is reconciled at posting.
When a claim is denied, we read the EOB, figure out why, and decide what to do. Some denials are fixable with a corrected claim. Some are worth an appeal. Some are not recoverable, and your practice needs to know that. We make the call based on the EOB reason, the documentation, and the appeal window.
Some claims do not pay quickly. The longer a claim sits, the more work it takes to recover. We watch for claims that have not been paid and follow up with the carrier. When a claim is past the appeal window, recovery rates drop, and we tell you which old claims are still worth chasing and which are not.
We submit electronically by default, through the major clearinghouses. A small number of carriers still require paper for specific claim types or attachments. Where that is the case, we send paper without making it a back-and-forth between offices.
Attachments and narratives are flagged at submission, not added later after a denial. The reason claim denials get worse over time is that supporting documentation goes in late. We send it the first time so the claim has a chance to get paid on the first pass.
A corrected claim fixes a clerical or coding error and resubmits within the original claim window. An appeal challenges a denial that the carrier issued on the merits. We choose between the two based on the EOB reason and the supporting record. Some carriers require specific forms or wording for appeals. We use the right one.
You do. When a claim has been sitting unpaid for a long time, we look at the appeal window, the documentation, and the carrier history, and then we tell you which claims are still worth chasing and which are not. The decision to write off stays with your practice.
Yes. Posted payments are visible in your PMS. Aging reports and collections summaries go to your inbox. You should be able to see the state of the receivable at any time, not only when we send a report.
Verification before the appointment makes the claims cleaner so fewer denials come back. AR cleanup is a separate one-time project for receivables that have already gotten old.
Day-before benefit checks so the claims that go out are cleaner from the start.
Insurance verification →Statements branded as your practice for the balance left after insurance pays.
Patient billing →A one-time project on aged AR, for claims and balances that have been sitting unpaid.
AR cleanup project →What an outsourced billing team actually does, where the practice still has to be involved, and how to evaluate one before signing.
Read the guide →How coordination of benefits works, primary determination, non-duplication, and what gets reconciled when both EOBs come back.
Read the guide →A 30-minute call about your practice, your PMS, your typical payer mix, and what is working or breaking right now in billing. We respond within one business day.