Service
Insurance Billing
After verification, the next part of the cycle is sending the claim and dealing with what comes back.
Insurance billing →We check what each scheduled patient's dental insurance will cover. The information goes on the patient's chart in your practice management software so the front desk can see it at check-in.
Before a dental appointment, someone has to find out what the patient's insurance will cover for the procedure they are scheduled to have. That work is called insurance verification. It tells the front desk whether the patient is currently covered, what the deductible and remaining annual maximum are, whether the procedure has frequency limits or downgrade rules, and roughly what the patient will owe at the visit.
Without verification, the office is guessing. Guessing wrong can mean the patient gets a surprise bill weeks later, or the practice fails to collect a copay it should have collected at the visit.
For each scheduled patient, we look at the procedure on the schedule and at what we already know about that patient. If a basic eligibility confirmation is enough (the patient is active, the plan is in-network, no surprises are expected), we do that. If a full benefit breakdown is needed (a new patient, a complex treatment plan, secondary coverage in the picture), we pull the breakdown.
A full breakdown covers active coverage, the deductible, the annual maximum remaining, frequency limits, missing tooth and replacement clauses, waiting periods, and the downgrade rules that apply to the codes on the schedule.
The information ends up on the patient's chart in your practice management software, in the place your front desk already looks. We aim to have verifications complete before the day of the appointment. We do not promise a specific time, because some verifications require a phone call to the carrier and that timing is not in our control.
Eligibility is a yes-or-no answer. It tells you whether the patient is currently covered, by which plan, and whether the plan is active. A full breakdown adds the details. It covers the deductible, the annual maximum remaining, frequency limits on cleanings and X-rays, missing tooth and replacement clauses, waiting periods, and the downgrade rules that apply to the procedures on the schedule. Eligibility is fine for a recall on a familiar patient. A full breakdown matters for a new patient, a complex treatment plan, or anyone with secondary coverage.
Yes. We pull both plans, work through the coordination-of-benefits rules, and note non-duplication, COB-takeover, and birthday-rule cases. The chart shows what each plan is expected to pay, so the front desk does not quote the patient the wrong number.
Open Dental, Dentrix, and Eaglesoft. We work in your existing PMS and put the verification on the patient's chart there, so the front desk and clinical team see the same record they always have.
We try the clearinghouse, the payer portal, and the phone in turn. Most carriers respond to at least one of the three. If a verification cannot be completed in time, we flag it on the schedule so the front desk knows in advance.
It is attached to the patient's chart in your PMS, in the place your front desk already looks. We do not ask the office to log into a separate portal to see it.
The cleaner the verification, the cleaner the claim that goes out, and the fewer denials come back. The other three services pick up where verification leaves off.
After verification, the next part of the cycle is sending the claim and dealing with what comes back.
Insurance billing →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 →The fields a real verification covers, broken down by PPO, HMO, and Medicaid. Print it or use it as a script.
Read the checklist →How coordination of benefits works, primary determination, non-duplication, and the workflow billers run when a patient has two plans.
Read the guide →A 30-minute call about your practice, your PMS, your payer mix, and what is working or breaking right now. We respond within one business day.