Question: How do you handle predetermination in your dental office?

Do you have a flow document and way to track it? Do you send pre-d on the same day as it was recommended or do you have one assigned day for handling them? What is the reason for selecting the way you are doing it?

ANSWER:  We don’t do too many predeterminations because it is our philosophy that no matter if the insurance says they will pay for a procedure or not, does not determine if the patient needs it. That being said, we do have some that go out.[mepr-show if=”loggedout”]Members only resources[/mepr-show] [mepr-active memberships=”629,630,37388,37393,37672,37676,37670,37668,37674,44674,232156″ ifallowed=”show” unauth=”message” unauth_message=”Answer hidden, please login or purchase a membership to view.”] For example, if someone is considering a procedure that is more of an optional type procedure or something that they can wait for a decision on, such as implant.

We send predeterminations on the same day or the morning after the consultation. Typically our process is that to stage the predetermination in Eaglesoft, like the claims do when patients get walked out. That night all the notes are put in for the day which will help us with adding narrative for the procedures that need it and the predeterminations, to help get them approved. The next morning the appropriate information is added to the claims or predeterminations and they are sent to the insurance companies.

We then pull predeterminations on a report much like outstanding claims and call on them as we call on open claims. Once the predetermination is received by the office, the treatment coordinator then calls the patient with the information and attempts to get them scheduled.

On one other side note, we started working with a company called eAssist that handles all of our insurance entering and processing. I wanted to share this because their entire focus is handling all of our insurance issues in the office. There are two reasons that I love it:

  1. ) it frees up my staff to focus on customer service and patient care and keeps them off the phones for hours with the insurance companies;
  2. ) and they are paid a percentage on insurance collections per month, so they are motivated to keep the claims and payments current and do their best to get the maximum payment possible for our office and patients.

I used to have to pay one full time employee to do all of that and to me that seems like such a waste of talent for a great employee who could be helping in the office and with patient care.

Thanks again for the question…. hope that helps.