Tracking Your Medical Claims in Your Dental Software

As medical billing for dentists becomes more commonplace it is becoming more and more frequent that major practice management software distributors are incorporating basic medical claims capabilities into their softwares. At the very least they are allowing for multiple creations of multiple categories of carriers to try to accommodate their dental clients.
Whether you are using an outside vendor for medical billing or sending your claims in-house you will need to find an efficient way to track your outstanding medical claims. With newer versions of Dentrix and OpenDental this is as easy as creating a medical claim. Both softwares give you the opportunity to create medical claims in their systems. For offices that are using products geared towards medical billing dentists, like DentalWriter, you may have a software that leans more towards being medical billing friendly than dental.
It is important to keep track of your medical claims for the same reason it is important to keep an eye on your dental claims. Maybe even more important as likely you have more than a few dental claims being held up awaiting medical EOBs. Many an appeal has had to be written to address the timely filing snafu that occurs from that arrangement.
If your software has the option for you to create medical claims the easiest way to keep track of your outstanding aging is to run an aging report – isolating your medical claims. Medical claims process in roughly the same time frame as dental claims, 30 to 45 days, so follow-up should begin at the 30th day and then commence every two weeks there on out until an EOB is received.
If your software does not have this option there are a few ways to keep current with your medical aging that can be managed easily. The first is a good, old-fashioned spreadsheet using Excel or Google Sheets. Another option, if you do not currently file secondary insurance, would be to use the secondary fields in your software to create claims that you could pull a report for and track. These would not necessarily be medical claims as they would not be on the proper form however entering them in the system in some fashion would give you an easy ability to track their status and enter notes.
Whether you are utilizing a billing agency or doing your own medical claims it is important to track your aging. Tracking your aging can allow you to easily see which claims your billing agency has not remitted to you yet for closure so you can quickly and easily follow up with them. If doing your own medical claims it gives your team an aging report to work off of just like your dental claims aging report.
Keep in mind also that if you are utilizing a billing agency all claims follow up should happen through them wherever possible. While it may be necessary to occasionally call on a claim yourself, if you need an answer sooner than their projected turnaround time, it should be avoided where possible. Medical claims are not like dental claims and requesting things like expedited review or transfer to a supervisor can result in your claim not being properly adjudicated as it is rushed through channels. Experienced medical coders are able to ask the right questions and evaluate whether the insurance representative’s understanding of the situation that is holding up a claim may be accurate. They are also familiar with case law regarding medical claims processing and know the proper keywords and terms to use when trying to navigate your claims through insurance channels.
Dental Billing Tips and News for Pros; Edition #131