Many claim problems start before the claim is even filed.
The problem
Your team tells a patient a procedure is covered. The patient schedules, you do the work, and the claim comes back paying less than expected or just plain denied. Now somebody has to call that patient and explain what happened. They are not going to blame the insurance company. They blame you.
It is tough to play a game when you do not know the rules. And if you are going to play the insurance game, you have to know three things. Whether the patient is covered. What the plan actually covers. And how much it is going to pay.
You have to know all of it before the appointment, and your front desk has to be able to explain it when the patient asks.
Getting paid starts with verification. A frequency limitation nobody checked. The wrong fee schedule. A procedure that was never covered. Every one of those was actually a verification problem before it became a billing problem.
And here is where our Benefit Verification Service can be a life saver.
What we do
With Smile Care Claims' Benefit Verification Service, we verify three days to a week ahead of the appointment, and check the fee schedule the plan actually pays on. We also have ASAP service for last minute verifications that can be done within 24-48 hours of the patient’s appointment.
We also set up a running system with your front desk for who has been verified, who still needs it, and where each one stands. Verification only works if both sides are looking at the same list.
Two levels of service
Choose how much you want us to handle
We can deliver completed verifications to your team for them to enter, or we enter all of the information directly into your practice management software.
Basic verification
We verify.You enter it.
- Verification completed ahead of the appointment
- Completed PDF uploaded to your shared folder
- Your team enters into your practice management software
Verification Plus
We verifyWe enter it
- Everything included in Basic Verification
- Information entered directly in your practice management software
- Nothing for your team to enter. We take care of it.
Depending on your needs, we run one of four types of verification for a patient. When each type might be used is worked out during onboarding, or communicated directly to your account manager.
Four types of verification
Simple verification
Confirms coverage is active and gives you the deductible and the remaining annual maximum. It answers whether the patient is covered, not what for.
Standard verification
Is the payer's own detailed pull, from the portal or a fax-back. It is the most benefit information for the money, which is why many practices land here for most of their verification.
Full verification
Everything in a Standard verification and a comprehensive breakdown, including frequency, benefit history, remaining benefits, and coverage details.
Custom verification
A Custom verification includes everything in a Full Verification plus a selection of specific procedure codes your practice asks for us to check.
See if we can help.
Let us deal with the insurance companies. Your team can focus on patients.
What if a patient schedules on short notice?
We handle it. Any verification you request inside forty-eight hours of the appointment is treated as an ASAP and moves to the front of the queue. It is priced differently because it displaces other work, and the rate is published on our pricing page.
Questions?
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Normally three days to a week ahead, depending on how your office prefers to work. We work all of this out with you during onboarding and keep a shared view of who is done and who is still outstanding.
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No, and you should not. Most offices get this wrong in the same direction. They over-verify.
What you verify should follow what your patients actually need. Over-verifying costs you either way. If you are handling verification yourself, it eats your team's time. If you are sending it to a company like ours, you’re spending more than you need to.
One client asked us during onboarding to add twelve custom codes to every verification. We looked it over and talked them out of most of it, because you do not need to verify a code you use on one patient in a hundred. It would have cost them real money every month for information they were never going to use. If they needed it for a particular patient, we would go get it. They did not need it for everyone.
So during onboarding we go through your list and tell you which codes are worth checking and which ones are not. We will tell you when you are about to pay us for something you do not need.
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Two, and neither is carelessness.
Verifying against the wrong fee schedule. A practice is contracted directly with a carrier, so it assumes that is the schedule being paid on. But the patient's specific plan sits under a leased network umbrella, and that is the schedule that applies. The office finds out when the adjustments start showing up.
Skipping frequencies and limitations. Coverage is not a yes or no. It is a yes with a waiting period, or a yes twice a year, or a yes if the last one was more than five years ago. A verification that does not check those is not a verification.
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No. Billing and A/R analysis and recovery are our core services. Verification is optional and priced separately, so you can add it later or not at all.
Still have a question? Call (800) 677-7142 or book a consult.
How do I get started?
Book a consult with one of our billing specialists. We will find out what you need help with and what you are hoping to achieve. And if we are a fit, we will walk you through exactly what we would do, what it costs, and what you can expect.
You will get a straight answer, including if the answer is no.