Why You Need Pre-Authorizations for Billing Medical Insurance for Dentist

Now, more dentists are offering treatments for certain medical conditions, like sleep apnea. While this offers a great service to the community and helps build your practice, it does come with a set of challenges. When treating medical conditions, you have to bill the patient’s medical insurance, not their dental insurance. As a result, it can lead to errors that could cause issues with the reimbursement process. When billing medical insurances for dentist practices, you need pre-authorizations. With insurance pre-determinations, you will ensure a procedure is covered under the patient’s insurance prior to offering the treatment.

Importance of Pre-Authorizations

After you have determined that a patient needs treatment, such as an oral appliance for sleep apnea, you need to request an authorization from the patient’s medical insurance company prior to providing the device. This not only saves the patient unnecessary costs, but helps to promote that you are reimbursed for the services. Although the process can take time, it is vital to both your dental practice and your patients.

It is important to understand that, although you have received a pre-determination, it does not necessarily mean the insurance company guarantees the payment. The insurance company will make it clear that the final decision is made after the treatment. With a pre-determination, you help to lessen the risk that an insurance company will not pay for the treatment.

Processing Pre-Authorizations

In today’s world, most pre-authorizations, such as those for sleep apnea medical billing for dentists, are processed electronically or over the phone. However, there may be an instance where the patient’s medical plan specifically requests a written pre-authorization. If this is the case, you will need to complete the appropriate medical claim forms, known as the CMS-1500. There are several elements of the form that will need completed prior to submitting it to the insurance company for approval.

Outsource Pre-Authorizations

As a dentist, the process of billing medical insurances can be quite complex and confusing as separate codes are required. This leads to costly and time consuming mistakes, while taking a great deal of labor from your staff. There is a simpler approach. With Brady Billing, we handle every aspect of insurance claims for medical procedures, including pre-authorizations.

We will secure the payment for medical services and equipment with verifications within 24 hours. We contact the insurance company on your behalf to begin the authorization process. We will send the documentation you have provided to promote a hassle-free process. Then, we monitor the situation and let you know as soon as possible if the claim has been approved or denied. In the event the claim is denied, we handle the denials, appeals, and negotiations process. By outsourcing your pre-determinations process, you and the patient will have a better understanding of the scope of benefits according to their current insurance plan.

Simplify Your Pre-Authorizations

By outsourcing your pre-authorizations and medical billing, your dental office will save time and money while enhancing the insurance process. Let Brady Billing help you. Contact us today to learn more about our services.