Red Flags to Check for On Claims, TP, & Schedule

Each treatment plan and claim should be checked for these items.  While this may seem time consuming and complicated, it will prevent many problems and save a lot of time for us and our patients.

Treatment Plans

Amounts

• Is the insurance paying something for each item?
• Is there a write-off for each item? (except UCR)?

Missing Tooth Clause

• All bridges, implants, or partials: make sure this doesn’t apply or manually update showing insurance won’t pay.

Sealants

• Not covered on adult teeth

Replacement Clause

• Check x-rays to see if we are working with a replacement or an original: Call patient for date estimate or call insurance for history.

Children

• If age four or under should they have Nitrous?

Co-pays: These often need added to each appointment.

• TDA DHMO $10
• Dentist Direct t$15
• Dental Select Gold Sterilization Fee $10
• Dental Select (all levels) lab fee.

***THEN SAVE VERIFIED TREATMENT PLAN***

 

Claims

Cone Beams:

Change all cone beams back to pano’s before sending claims except with the following companies who pay for cone beams:

• All UCR plans
• Metlife
• Delta Dental
• GEHA/Connection
• Diversified

  Pano's:

  If a patient gets one before they are eligible and billing with BW's, then split off, mark received, and write off today.

SCRP:

Split off and mark received today on the laser curettage code for the following companies:

• Delta Dental
• Guardian

           

Schedule

Tetris Schedule: for 2-3 weeks out

Look for Follow-up items

• Labs: crowns, space maintainer, dentures, and flipper.
• Implants : order and start the antibiotic 2 days before.

Co-pays: These often need to be added to each appointment. See the list above

If appointment is over 90 minutes or services more than 2 family members.

• Leaving a message is not good enough, we need confirmation.
• Remind patient that because of length or the number of people. A missed appointment fee can be more than $100.