Dental insurance verification: the essential information to obtain

Table of Contents

1. Key Patient Information for Verification
2. Primary Dental Insurance Information
3. Secondary Dental Insurance Information

Effective dental insurance verification requires gathering essential patient data to facilitate accurate claims processing and ensure a smooth revenue cycle. Ensuring all necessary information is captured upfront can prevent delays, reduce errors, and enhance patient care. Below, we outline the critical demographic and insurance information dental practices need to collect for each new patient.

Key patient information for verification

To start, verify basic patient information that helps establish their identity and contact details:

• Name: Recording the patient’s full legal name ensures accurate record-keeping and insurance verification.
• Date of Birth (DOB): The birthdate is essential for identification and eligibility checks.
• Social Security Number (SSN): While not always required, the SSN can aid in unique identification and may occasionally serve as a member ID.
• Address: The current address is necessary for correspondence, billing, and processing claims.
• Phone number: Include contact numbers for appointment reminders, inquiries, and emergencies.
• Email address: Email provides an additional channel for communication and reminders.
• Emergency contact information: Collect the name, relationship, and phone number of an emergency contact in case of urgent situations during dental procedures.
• Date of last dental visit/exam: Knowing the date of the last dental visit helps assess the patient’s dental history and determines if their insurance’s frequency limitations for exams and treatments have been met.

Primary dental insurance information

Accurate details about the primary dental insurance policy are essential for efficient verification:

Subscriber Information: Always confirm with the patient whether they are the policyholder. If not, gather the policyholder’s details as follows:

• Name: Full name of the policyholder if different from the patient.
• Date of birth (DOB): Birthdate of the subscriber for verification.
• Address: The current address of the policyholder for verification and correspondence.
• Employer associated with plan: The employer information can assist in identifying the group number if necessary.
• Relationship to patient: Clarify the relationship between the subscriber and the patient (e.g., self, spouse, parent).

Insurance company information

• Insurance company name: Record the name of the insurance provider.
• Member ID: Confirm and note the subscriber’s unique identification number, which may or may not be the SSN.
• Group number: Capture the group identification number tied to the insurance plan.
• Mailing address for claims: Verify the correct address where claims should be submitted.
• Provider phone number: Collect/confirm the contact number for inquiries and verification needs. It may not be the same as the provider service number on the insurance card.

Secondary dental insurance information

If the patient has secondary coverage, repeat the steps outlined for primary insurance. Be sure to follow coordination of benefits rules, as claims won’t process correctly if a dependent is listed as the policyholder instead of the true policyholder.

By capturing complete and accurate insurance and patient information, dental practices can streamline the insurance verification process, minimize errors, and improve the patient experience. Remind patients about the importance of providing this information, and always request copies of the front and back of insurance cards to confirm details, especially when information is obtained by phone.

This structured approach to dental insurance verification helps ensure all critical data is collected, setting the foundation for an efficient and error-free revenue cycle.