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# A Simple Guide to Dental Billing Authorization for Providers

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- October 9, 2024

When it comes to dental treatment or procedures, patients need to be aware of their insurance coverage. However, the policies are sometimes hard for laymen to understand. On the dental office’s part, it is time-consuming for the staff to first go through the coverage policies and then comprehend the terms to patients.

Also, with insurance policies changing almost every year, it is hard for dentists to understand how they will be paid for the services rendered. This is where pre-authorization, also referred to as authorization, comes into play. It helps dentists understand a patient’s coverage.

Complications arise when a treatment is pre-authorized in the policy and performed by the dentist, but the submission gets denied.

Hence, the service provider has to face payment rejection. There could be many reasons behind it, i.e., the patient is no longer eligible, the maximum allowable has been paid, or the time period has been exceeded. It is worth noting that the pre-authorization process doesn’t guarantee payments from the insurance.

## The Role of Pre-Authorization

Also known as pre-approval, this process involves dentists getting approval from the carrier prior to providing certain dental treatments. Simply put, this process clarifies if a procedure falls under the patient’s insurance coverage and if there are any restrictions.

Before discussing further about the authorization process, like the time taken and how it works, let’s glide through some of the authorization benefits for dental billing.

## Benefits of Pre-Authorization for Dentists/Dental Practices

Dental pre-authorization has many advantages for patients as well as dental service providers. Here are some of the most significant.

### Financial Security

The pre-authorization process safeguards a dental practice’s financial stability. By going through the process, dental practices protect themselves and their patients from unforeseen financial issues. They also have a clear picture of which procedures are covered by the policy and what expenses the patient will incur.

### Lower Claim Rejections

Rejected claims are a major setback for any dental facility. They require more time and effort to resolve. It involves delayed payments due to rectification of errors, resubmission, and multiple follow-ups with the insurance. Dental pre-authorization lowers the risk of bill rejections by ensuring that the policy covers the treatment before providing the service.

### Enhances Patient Satisfaction

Pre-authorization ultimately turns patients into happy patients. Clarity in communication and process lets them know whether they are eligible for the treatment and what costs will be incurred. Also, dentists can provide accurate costs, hence lowering the surprise factor regarding insurance coverage.

Apart from the advantages mentioned above, pre-authorization guarantees

- Streamlining of the billing process
- Improved efficiency and accuracy
- Reduced billing errors

## Significance of Pre-Authorization

Pre-authorization is one of the most crucial steps in dental billing. It ensures that the patient policy includes the procedure costs and that the service provider will be reimbursed for the treatment provided. Here are some of the points that show why it is crucial.

- It helps to control expenses and the possibility of under or overprescribing.
- It ensures that the service or medication prescribed is necessary for the patient.
- It ensures that the service provided isn’t duplicated, especially when multiple dentists are involved.
- It helps to decide if the procedure is beneficial against the patient’s condition.

### Process of Pre-Authorization

Pre-authorization for dental billing or dental service providers is a time-taking process involving the following steps.

### Contacting The Provider’s Office

Also known as prior authorization, most payors mandate this step of the process for specific oral services, procedures/treatments, prescriptions, and durable medical equipment. This step demands you to contact the provider’s office and give them the following information. It includes providing:

- Name, D.O.B., complete address, and contact number.
- Insurance plan details and member IDN.
- Details of the service, equipment, and medications that require pre-authorization.
- Exact date of the dental service/delivery.
- Identification number – if known.

### Completing The Paperwork

Once you’ve established contact with the provider’s office, you have to complete the following paperwork.

- Personal information
- Insurance plan details and member IDN
- Exact date of the dental service/delivery
- Mention as much detail as possible about the service, equipment, and medications that require pre-authorization.

### Organizing The Paperwork

After collecting all the essential requirements, you must submit the information to the insurance provider. It is important to provide all the information demanded; otherwise, the chances of your request being rejected are high.

To make it easy for you and the provider, ensure that you submit the paperwork electronically. You can submit your paperwork through their online portal. Every renowned insurance in the US has an online portal. If you’re doing it by mailing hard copies, it is better to keep the duplicate copies for your record.

### Meeting The Deadline

One of the most important advice for dental providers is to submit their paperwork as early as possible without waiting for the deadline. Your insurance company’s guidelines may mandate you to submit the pre-authorization request weeks before the service date.

Contact your insurance provider to find out how many days or weeks in advance you need to inform them.

## Try Again in Case of a Denial

For some reason, if your pre-authorization request is rejected, you can try submitting the request again. The denial could be due to late submission, any error in documents, or the inability to provide the correct information. So, don’t hit the panic button yet. Contact the service provider and retry again.

This time, ensure you submit complete documents containing the correct information within the timeframe. Leading dental billing companies like Apex Dental RCM can assist you with guidance and submitting the required stuff for pre-authorization. We also provide services to enhance your revenue collection.

## Steps to Take in Case Your Request Is Denied

When your request for pre-authorizations is rejected, you, as a dental practitioner or facility, may have to pay for treatment by yourself. In case of a denial, these are the steps you should follow.

### Appeal Against the Decision

If the request gets rejected, you have the right to appeal the decision. All you have to do is gather evidence to support your case and submit it to the coverage provider.

### Negotiate

Negotiation with your insurance company is a vital step you need to master. If your insurance provider doesn’t cover the cost of the dental treatment, prescription, medication, or durable medical equipment, you can and should negotiate with the company to lower the expenses.

### Look for Other Options

If your case is rejected, try looking into other options. For instance, you can pay for dental treatment using a credit card or even by taking a loan.

## Challenges in Pre-Authorization Process

One thing to note here is that the entire pre-authorization process is not only time-consuming but frustrating for patients and providers. Some of the common issues that arise due to rejection are:

- Delays in prior approval
- Coverage rejection
- Disclosure of limited information regarding what things are covered
- Not enough instructions regarding required information
- Trouble getting in touch with the right person in the insurance company

All or any of these problems create problems like delayed treatments or pending payments for patients and dental practices, respectively. This is where a renowned dental billing company like Apex Dental RCM can act as a savior. Our experience and over 1000 professional dental billers can ensure a fruitful pre-authorization process.

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