Are you on the fence about outsourcing insurance verifications? Here’s how to know whether you’ve exceeded the limit of your own resources—and the most important questions to ask a potential partner.

By Amy Hernandez

DO I BELIEVE that outsourcing insurance verifications is efficient, cost-effective and stress-saving for most dental offices? Yes. But is it right for every office? Not necessarily. Some practices prefer to keep certain tasks in-house, while newer startups or more budget-conscious offices may hesitate to invest in fee-based services without a clear ROI.
So how can you be sure outsourcing insurance verifications is the way to go? It’s  important first to make sure your systems and records are in order. Start with cleaning up your software and verifying that the insurance names, addresses, group numbers and employer names are accurate. This will ensure that your team isn’t requesting the same verification multiple times from the same employers and group numbers.

It’s essential to gather the whole group number, including the subgroup number, to determine plan specifics. The numbers for the plan you’re requesting differentiate the plans—so at a minimum, align yourself with a verification coach who can teach your team how to request proper verifications and eliminate duplicate entries. Ensure costs stay low in your office while still obtaining the necessary information for the verification form.

If you’re doing everything right but still considering outsourcing, ask yourself why. Is your team short on time? Are you struggling to hire or retain experienced staff for this role? Or are you spending too much time training new hires? Finally, do you want to increase same-day start of treatment in more instances?

Once offices start getting paid faster and with less stress, they rarely want to go back.

If the answer to one or more of those questions is yes, you should probably start considering your outsourcing options. What should you look for? Here are some questions to ask.

• “Does your product integrate with my software, and if so, how much manual intervention will it take to make the transition?” Most verification companies provide only PDFs, leaving your team to manually enter downgrades, limitations and deductibles. At PPO Profits, we handle all that for Open Dental and Dentrix users. Submit your patient list, and we take care of the rest.
• “Is it solely AI-based, or is it manual?” There are benefits to both, but it’s essential there be some human touch.
• “Where are we gathering this information?” Should you rely solely on insurance portals or speak with a customer rep to obtain the necessary information? A combination, ideally. All information you need will not be available on most insurance portals, so calling for a few additional codes will be necessary.
• “Who on our team will be responsible for requesting verifications?” There will still be some legwork for your team to ask for information from the outsourcing company, so be aware that this is not an entirely hands-off concept.

While the process can’t be fully automated, outsourcing will wipe away the biggest hassles: receiving all outstanding insurance claims and submitting them, posting payments both from checks and EFTs and then appealing denied claims and following through to closure. Once offices start getting paid faster and with less stress, they rarely want to go back. Bottom line: Leaning on a well-chosen outsourcing provider helps you maintain stable monthly income while your team stays focused on patient care. n

AMY HERNANDEZ leads the revenue cycle management division of PPO Profits, one of the market’s leading providers of dental fee negotiations. Previously, she was founder and CEO of Dental Performance Experts, a PPO claims processing and accounts-receivable firm, before selling it to PPO Profits and joining that company. PPO Profits is now part of Benco Dental, the publisher of this magazine. Contact Hernandez at AmyH@PPOProfits.com.