Dental insurance can be confusing. It’s important that you’re billed only for the services you receive and that you are covered for the services in your insurance plan. We keep track of everything through insurance claims auditing. We make sure all of this is processed correctly by auditing submitted claims.
Here are the basics of insurance claims auditing:
Insurance Claims Audit for In-Network Dentists
Dentists are required to submit claims for any work they perform on their patients.
After your dentist submits the claim, we review the claim to make sure that:
1. Your dentist actually did the work.
2. Your benefits were applied correctly to the claim.
Our dental insurance claims audit processes ensure our members are protected from fraudulent billing practices or incorrectly applied coverage and our dentists are providing the best quality service to their patients. For example, if X-rays from your dentist don’t match the work listed on the claim, we can request clinical notes or a narrative for verification.
A Secure Claims Audit Program Has a Paper Trail
We collect all relevant information from the dentist through email or mail. We don’t generally conduct a dental insurance claims audit over the phone because it’s important to have a paper trail for consistent documentation.
Your Explanation of Benefits Letter + Our Claims Audit Program
We process the claims by comparing it to your benefits package. This is where your EOB, or explanation of benefits, comes into play. Remember that piece of mail that comes after going to the dentist? It reads, “This Is Not A Bill,” in bold letters across the top. It’s the breakdown of the services your dentist submitted for you.
You shouldn’t have to take any action when you receive an EOB unless you:
- Didn’t have the services done.
- The services outlined are different from those you had at your appointment.
If you ever feel that there has been an error or something was processed incorrectly, contact us.