01/31/2018

Hang up and log in for dental plan benefit information


To transport or be transported across space and distance instantly: That’s the definition of teleportation, and although it may sound like something from the future, in reality, this form of communication is taking place even as I write. In fact, you may have noticed that the ADA added two new CDT codes for teledentistry for 2018.

While you may not be interested in adding teledentistry to your practice just yet, a more common form of telecommunication is available to you and the dental community right now: benefit plan online portals.

Many benefit plans have online portals that contain a wide range of resources to help you, your patients and your practice do business simpler and quicker.

In the past, an office would call a benefit plan, reach a live representative within minutes and be able to check eligibility, get a breakdown of benefits and check claim status. 

Today, if an office is lucky enough to find its way through the plan’s complex interactive voice response system, it is not unlikely that the office could then wait an hour or longer to speak with a live representative. 

To try to contain costs and meet the ever-growing demand for instantaneous information, benefit plans have started offering information through their own online portals. As you may have experienced yourself, when these portals were first introduced, the information offered was insufficient at best and in most cases still required an office to call the plan with many unanswered questions. However, this is less the case today as many plans have worked to improve their portal functionality to better meet the needs of the dental community. 

In addition, many plans are pushing the provider community toward self-help services by limiting access to a live representative. 

If you have not taken advantage of these self-help opportunities, take some time now to familiarize your practice with the many options available. Let’s take a closer look at the most common of them.   

Online Portal

An office will find that many plans’ portals provide access to their patients’ eligibility, benefits, treatment history, frequencies, remaining maximums and deductibles. Many plans also have features to transmit claims and predeterminations free of charge, and the direct connection to the plan’s processing system makes payment and processing very fast in most cases. In fact, it is not unheard of that a provider could send a claim via a portal and have payment in their account within the same week. Additional functions give offices the ability to check claim information, e.g., status and payment data.

Other features frequently include the ability for an office to enroll in electronic funds transfer or update its existing EFT account information.

If you are tired of filling out forms over and over again to comply with state Senate Bill 137 requiring accurate benefit plan directories, look to online portals. Many give you the ability to comply online with just a few clicks. 

If you’ve misplaced the plan’s handbook, check the online portal before you pick up the phone to call the plan and pay a replacement charge; the handbook is usually housed in a reference library.

If you’ve tried to complete a treatment plan but have misplaced the plan’s contracted fee schedule, why call the plan and spend time waiting on the phone just to be told your request cannot be fulfilled by the contact center and that you will receive the fee schedule in a few weeks via mail. Most plans house fee schedules on their online portal. Check the portal’s homepage for keywords like “contracted fees.”

If you are interested, but aren’t sure how to get started, first visit the plan’s website. In most cases you will find how-to video tutorials with helpful information on everything from how to register to how to attach an X-ray. If watching the videos does not answer all of your questions, look for a link to sign up for webinars that will offer a chance to ask detailed questions and receive feedback from a trainer.
 
Email

Today, many plans offer benefit breakdowns via email, making it unnecessary to wait on hold to get a breakdown when in most cases you can get this information within minutes. Simply call the plan and, when prompted, select the option to receive the benefit breakdown in an email. This is a great option when you have a new patient and need a full breakdown of benefits.

Additionally, if you have a patient who disagrees with you about his or her dental benefits, an email directly from the plan that can be viewed by the patient can help clear up any misconceptions about benefits.

Fax

If online services are down, again, there is no need to wait for a live representative on the phone when, in most cases, you can follow a prompt and select the option to receive a breakdown within minutes via fax.

Let your voice be heard; do not hesitate to speak up and tell the plans what is or is not working with their tools for the dental community. If you do not see a feature that you feel is needed, let them know by sending an online comment. They are interested in hearing from you. In fact, many even invite office managers for brainstorming sessions to try to learn what is or is not working for the dental community. 

In conclusion, hang up the phone and stop waiting for answers that in most cases are available with just a few clicks.

This article was authored by Cindy Hartwell, dental benefits analyst, CDA Practice Support.

Find dental benefit resources in the Practice Support section of CDA’s website.



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Have you ever had one of those moments when you received a decision from a dental benefit plan and thought, “There ought to be a law?” Well, there isn’t a law, in many cases. All health plans must meet requirements as determined by the state agencies that regulate, license and certify them. However, the issues that matter most to providers as well as patients — what is included in the plan’s scope of benefits, for example — are not governed by state laws or regulations.

CDA Practice Support occasionally hears a complaint from dental offices that a plan granted a preauthorization for treatment and then denied payment when the claim was submitted. Digging a little deeper into these complaints, there may be some confusion between what constitutes a “preauthorization” and what is a “predetermination” or pre-estimate of benefits.

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