Reviewing and Maximizing Open Claims

June 16, 2020

Dental Practice and Productivity

While a number of dental clinics may be open during this crisis, federal and state guidelines limit the ability of the clinics to operate for emergency purposes only. Consequently, the current situation leaves dentists and staff with more time than patients.

So, aside from sanitation activities that ensure a COVID-free workplace, what can dentists and staff do during work hours?

In one of Benco Dental’s webinars, guest speaker Dr. Roy Shelburne, DDS, suggests that dentists and their staff should go back and review any outstanding insurance claims to “mine any gold” that is still there.

What is an Open Claim?

In insurance vernacular, an open claim is one that has yet to be settled, where the insurer expects to make future indemnity and expense payments on behalf of the insured.

In the context of a dental practice, dental insurance payouts equate to approximately 50% of the total practice income. So, having an open claim is something dental clinics should constantly manage and monitor with extreme dedication and accuracy.

Important Things to Remember when reviewing open Claims

“This is a perfect opportunity to sit down and go over all those things in the back of your head that you said only if I had enough time, I would do that. But this is a time to be able to do that. And I want to encourage you.” -Dr. Shelburne, DDS. Webinar on Coping During Crisis.

I. Open Claim or Write-off?

First of all, start by determining how long a claim has had an on open status. Then you need to compare the amount of time the insurance company gives you to either send a claim if you’ve not sent it; or to appeal the claim by adding additional information.

However, If it is something that needs to be written off, then do so. Alternatively, if it is something you think you might be able to challenge, then absolutely start there since that is potential income for your clinic.

II. Importance of Documentation

According to Dr. Shelburne, the importance of documentation cannot be ignored. A detailed account may not only convert an open claim into potential income, it can also spare a practicing doctor from being implicated with money laundering or intent to defraud. So, always remember to keep detailed records of every patient visit.

III. Intraoral Camera

One aspect of enforcing your documentation is having an intraoral camera present during a patient’s operation or consultation. Dr. Shelburne advises that the best way to increase your case acceptance rate for open claims is to have photographic records and documentation.

IV. Electronic Attachments

Most dentists and support staff should already be familiar with mailing attachments electronically. However, for those who haven’t transitioned, Dr. Shelburne points out its advantages over paper claims:

  • Electronic claims enable you to track sent documents through an attachment software like NEA-Electronic.
  • Electronic claims are more likely to be prioritized by insurance companies compared to paper claims.

Finally, Dr. Shulburne reminds dentists to always ask insurance companies to renegotiate their fees and to review an insurance plan to see whether it is worth participating in. Furthermore, he adds that the current situation is perfect for telemedicine in the dental sector to flourish.