Looking for an intermediary to adjudicate your dental claims? Feeling stuck in the midst of dealing with a difference in opinion to that of your dental insurance provider? Dental claims adjudication enables the member to be informed, by accurate evaluations, of the insurance reimbursements that they will receive from the insurer with respect to the medical claim applied for. We at Outsource2india are here to resolve all your disputes and make sure that you get your dues.
With an impressive track record, we are the most sought-after dental claims adjudication services in India. Our claims' processing expert negotiators strive to rectify errors, workout your denials and help with re-submissions. We explain all the details in an understandable manner all the while keeping you informed about the entire dental claims adjudication process. Outsourcing your dental claims adjudication services to us will have you stress-free.
Assorted Dental Claims Adjudication Services We Offer
Over the last 24 years, Outsource2india, smoothly and efficiently handles dental insurance claims processing. We are, without a doubt, the best dental claims adjudication service provider in India. Here are some of the major services that we are pleased to provide -
Determination of Claims Value
The accuracy and extent of the insurance coverage for a dental procedure is evaluated. These criteria are used assertively for deliberations so that you get the maximum benefits of the claim amount especially in cases where the insurer wants to minimize the claim value.
Preparation of Explanation of Benefits (EOBs)
A detailed and comprehensible explanation of remittance advice is provided for your perusal. For secondary and tertiary claims, we mandatorily include the following information -
- Payer Paid Amount - The reimbursement made by the insurer
- Approved Amount - This indicates the total claim amount approved
- Allowed Amount - The amount of total claim value permitted by the insurer
- Covered Amount - The amount of total claim value covered by the payer
- Discount Amount - Primary payer amount or adjustment as per terms of the insurance
- Patient Responsibility Amount - Amount for which the patient is responsible for. This includes co-payments, deductibles and co-insurance payments
- Dental Adjudication Date - The date the claim was adjudicated and/ or paid in part or full as per the policy criteria
Claims Validation and Fraud Detection
We gather all data such as dental procedure details, bills, invoices, statements etc. The documentation is assessed, and dental procedures are investigated thus ensuring if the claim is legitimate. We thoroughly scrutinize the terms and conditions of the policy. We alert you of the slightest suspicions detected or any uncalled- for complications that arise. All fraudulent and lapsed claims are flagged off right from the start.
Evaluation for Duplicate Claims
It is one of the major reasons for claim denial. Duplicate claims may be submitted for several reasons like if the payment wasn't received even after assurance, lack of coding and/ or billing knowledge of various health plans or re- submission of the same claim after adding new information. We ensure that no such administrative errors occur during our processing.
Adjudication of Claim Benefits
All applications with incomplete details, mismatched coded, invalid documentation are electronically (and sometimes manually) weeded out once entered the billing software. Approved documents are cross-checked for compliance as per the insurance payer's payment policies. All approved claims that pass this stringent step are then issued a remittance advice statement.
Data Extraction from Raw Claims
We precisely extricate data components from raw claims. This reduces backlogs and delays. We handle is in an efficient, compliant and an accurate manner.
Verifying Data with Claims Adjudication Engine
Our latest dental claims adjudication software allows for enhanced transaction processing. With automated operations for verifying data entry for claims adjudication, enrolments, eligibility criteria, billing etc. This accounts for speedy processing and high- accuracy of the entered data.
Review of Diagnostic Dental Codes and Patient information
We are equipped with complete details of Current Dental Terminology (CDT) for oral health and dentistry maintained by American Dental Association (ADA). We also have extensive knowledge of all dental codes required to code each dental procedure(s) for dental insurance plan submissions.
Detailed Evaluation of Dental Insurance Providers
All insurer information is collated after an intense background check and we have thorough knowledge of all the terms and conditions of all their policies. We can help you decide on which dental insurance provider for in the future to best suit your needs.
Execution of Adjudicated Claims
With a systematically developed process management method we ensure that no claim is denied or must be resubmitted. Hence no delays can be encountered in the dental claims process. If your claims are wrongly denied, we handle the application procedure as per our methodology and ensure that the scales are tipped in your favor.
Claims Adjudicating Entitlement
Here we ensure that the full right to payments is received as per the policy entitlement. We submerge ourselves and go through great lengths to intercede and overturn any obstacles.
Claim Amount Calculations
We compute the claims amount. We notify you of all details on co-payments options, deductibles, as well as insurance plan exclusions so that you are prepared beforehand of the reimbursement amount that you will receive.
Down Coding and Bundling Assessment
We thoroughly scrutinize cases where a claim is down coded- wherein the claim is adjudicated in a manner that reduces dental procedure codes to a lower- cost code. In such cases, we ensure that you are provided with the pay- out that you deserve. We evaluate cases of bundling wherein similar dental procedure codes are collated or grouped together resulting in combined submitted charges. We make appeals if we find the reimbursement amount reduced in any such instances.
Benefit-based Determination Adjudication
For adjudication based on benefit, each claim is scrutinized and adjudicated as per the advantage it provides for a dental procedure and the reimbursements released as pre- decided by the claim. We determine the accuracy, time-limit and fairness of the remittance as promised by the insurance company.
Intimation of Claim Status
You will be notified at every stage of the progress of your application via online tracking of claims application. This can be assessed by you at any given time. This is crucial so that we quickly rectify any corrections so that the claims are swiftly processed.
Re-adjudication of Dental Claims
Any denied claims are re-adjudicated with the help of relevant documents recovery. Claims are then resubmitted for approval to your chosen dental insurance company and guaranteed that a settlement is reached at the earliest.
Dental Claims Adjudication Process We Follow
Outsource your dental claims adjudication services to us for faster resolutions and peak benefits within the least time span. You can approach us for dental claims adjudication solutions to any/ all your questions, doubts and uncertainties at any moment. Our team can be pinged for their support with all future dental claims adjudication services without any hesitations. We also help you decide on the policies that you can settle for according to the dental procedures you conduct. The assessment of all claims is done in a stringent manner. Here are the steps that are systematic followed by us for medical claims adjudication -
01. Claims' Eligibility
Dental claims processing is initiated based on the authenticity of the accumulated data.
02. Data Entry
All verified dentist information, dental treatment details, CDT code information are entered into the current billing software.
All claims are thoroughly examined for accuracy.
04. Cross-checking for Duplicate Claims
All duplicate, lapsed and/ or falsified claims are flagged.
05. Benefit Determination
A detailed Explanation of Benefits (EOBs) is prepared.
06. Evaluation of Dental Details
We ensure that all details are valid and correctly provided to the insurance company to start the claim process at the earliest.
07. Coding, Bundling and Diagnosis Review
Thorough assessment and review of all claims is done.
08. Rules-based editing/Processing
We sure that you comply by the policy rules and regulations.
09. Intimation of Claim Status
The progress of all claims adjudicated is closely monitored via our online tracking system.
Regular follow-ups are done with the insurance company ensuring no delays in final payments.
11. Claims Settlement and Presentation
The final claim value is verified according to our calculations to ascertain that there is no difference in the claim value which is presented to you.
Any denied claims are re- adjudicated and resubmitted for approval.
Multi- tier Review for Intense Assessment
We spare no effort in providing you with the best services available online. We are transparent with all our deals and our process is clearly explained in an articulate manner. With a reputation for high-accuracy we abide by our strong system developed for assessment, the steps of which are as mentioned below -
Initial Claims Process Review
This is the initial and crucial stage of claims assessment. We ensure that every detail is entered correctly. We check for the following criteria -
- Errors in spellings of patient names or other data entered
- Incorrect/ Invalid identification numbers/ plan number etc.
- Incorrect service codes and service dates
- Patient's gender mismatch
- Any document with an invalid/ wrong diagnosis code
Automated Claims Review
We immediately pick on any wrong submissions. This step is crucial for detecting any incorrect claims which can then be rectified and re-submitted. This saves a lot of time. Hurdles that could arise in this step are -
- Duplicate Claim Submission - Any duplicate claims discovered are flagged
- Claim Eligibility - Any missed payments towards the insurance company can lead to disqualification of the claim compensations
- Needless Service Delivered - If a dental procedure is performed that isn't required or done unnecessarily than the insurance company has every right to deny the claim and if they intimate you of the same, we stand by their side
- Mismatched/ Invalid Diagnosis and Procedure Code Entry - Every so often the diagnostic and procedure code are wrongly entered into the billing software. The early correction of which saves a lot of inconvenience
- Invalid pre-authorization - The details submitted for pre-authorization do not tally with the diagnostic procedure performed
- Claim after Lapse of time - Any insurance claim that has lapsed results in immediate halt of the claim's process
Final Manual Claims Review
We cross-check for any missing/mismatched or invalid data. We authenticate all documentation crucial and mandatory for the claim process. This is a fundamental step for verifying the medical importance of claims that are made for unlisted procedures.
The three type of payment determinations are as mentioned below -
- Paid - Payer determines if the claim can be reimbursed when the healthcare is considered paid.
- Denied - Insurer determines if the claim cannot be reimbursed when the dental claim is denied.
- Reduced - When the bill amount is high with respect to a diagnosis then the procedure code can be down- coded.
Final Pay-out Details
Finally, we submit the payment to the office notified by the insurance company. This is called the explanation of payment and includes a detailed report of reduction in payment, denial, adjustments, and the explanation of benefits (such as allowed amount, paid amount, approved amount covered amount, patient responsibility amount and adjudication date).
Other Services You May Benefit From
Why Outsource Dental Claims Adjudication Services to Outsource2india?
We are the best at what we do and opting for our services will additionally provide you with the following -
We possess the latest billing technology and latest tools to speed up the claims process.
Patient Data Security
All data is secure with us. We strictly abide by our non-disclosure agreement wherein we do not disclose any information.
All our results are in accordance with the Health Insurance Portability and Accountability Act (HIPAA) standard.
Our services are a value for your money. We spend a lot of time looking into the minute details of all information provided and cross- checking it with the insurer's policy terms and conditions.
With a team adept at handling claim disputes and denials. We help overturn any refusals in our favor and obtain the maximum claim amount.
Our flawless services entitle you to faster dental claims adjudications with a considerably low denial rate.
Single Point of Contact
All your policy and queries will be handled by an efficient executive eliminating any confusion with dental claim dealings. You are thus provided with the perfect assistance.
Remote Dental Billing
If need be, all your software can be remotely accessed, by our certified crew, in real- time.
Our multi-tier review and scrutiny of all minute details ensure higher success rate of majority of dental claims. This helps us optimize claim managements as well as conduct predictive analyses to overcome potential denials.
With our adjudication management system and swift handling, we are focused on providing you with all reimbursements at the earliest.
Data Archiving and Extraction
All claim files are meticulously arranged for immediate retrieval at any point in the future.
Claims Coding and Formats
We are known for our accurate report submission based on in-depth knowledge of CDT, HCPCS, revenue as well as other typical dental billing codes.
Insurance Fraud Detection
We can predict and identify any fraudulent activity thus helping you evade or fall prey to any deception.
We priorities your claims based on the severity of the statement issued after denial.
Our services can be utilized worldwide across all time zones. Our team can be contacted via chat, phone, e-mail or across our social-media platforms 24/7 throughout the year to set you up with on-site consults and the required help.
Client Success Stories
Helped the Client Streamline their Eligibility Verification Process
Eligibility verification, pre-authorization, and A/R follow-up were among the list of services we offered to a reputed clinical billing consumer. Our reasonable rates combined with a high-quality process made the client happier.Read more
Provided Pharmacy & Medical Insurance Eligibility Services To A Telemedicine Provider
A birth control telemedicine provider received eligibility verification services from us. We were successful in honoring our commitment and assurances to the project.Read more
Outsource Dental Claims Adjudication Services to Outsource2india
Overall, I am pleased with the support. The response time and communication were fine. Knowledge of billing and claims was above the expectation. I recommend Outsource2india to those who are contemplating claims adjudication services from an experienced partner.Founder, Medical Device Market Strategy and Reimbursement Company, Tustin, California More Testimonials »
Outsourcing dental claims adjudication services to Outsource2india will provide you with the approvals to maximum remunerations in a short period of time. Trusting us will help save resources and spare you the tedious technicalities of the entire adjudication process. You can also avoid the rigorous process of hiring and training any new staff to handle the dental claim process. Our meticulous methodology and high-success rate of dental claims adjudication is currently unmatched online. We are known to be reliable and trustworthy in all our dealings.
Get in touch with Outsource2india today, the leading dental claims adjudication provider for a free quote. Choose us for available online and be assured of unwavering support towards your dental claims adjudication needs.
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