Claim More Insurance Profit

June 1, 1996
Why will a dentist, who floods the office and home with high-tech equipment, still require the office staff to fill out dental insurance (DI) forms by hand? That dichotomy is tough to figure.

Duane A. Schmidt, DDS

Why will a dentist, who floods the office and home with high-tech equipment, still require the office staff to fill out dental insurance (DI) forms by hand? That dichotomy is tough to figure.

Dental insurance experts, Dr. Tom Limoli and his son Tom Jr., of Atlanta Dental Consultants, report that 90 percent of the nation`s dental offices slog through non-electronic DI claims. Why have 10 percent of your colleagues chosen to wire their insurance claims? I`m going to spill their secret.

Eight years ago, Dr. Joel Garblik founded the National Computer Claims Services. He now is an electronic-claims expert with ENVOY-NEIC CORPORATION, a "clearinghouse" that fills an All Payer/All Player role in "EMC," Electronic Media Claims. Dr. Garblik says there are profits hidden in the pile of insurance claims that pile upon your business desk.

The System

Submitting insurance claims by wire is less complicated than using an automatic-teller machine (ATM). To start, you must own a computer. The practice management system (PMS) software that runs the computer must be smart enough to send claims over a telephone wire, to which it is engaged. Most PMS`s have those smarts, a few don`t. Here`s what happens:

1. Upon command, the system writes the day`s insurance claims, telephones toll-free to the claims clearinghouse and zips them on their way. Time? Maybe 20 seconds. Until you haul the money to the bank, you have nothing else to do!

2. The clearinghouse checks the claim for accuracy, then sends it to the correct carrier. The clearinghouse reports back that the insurance company now holds your claim. Claims lost in the mail are rarely recovered and yours cannot be lost.

3. When the carrier staff arrives for work the next morning, the claim-for work you did only yesterday-nestles inside the carrier`s computer, ready to be processed, adjudicated and paid.


1. You need hardware. But then, consider that you must own several other pieces of equipment to practice dentistry, like a handpiece, for one. Your computer hardware will assure you receive the money your handpiece earns.

2. You need software. Ask your PMS software dealer if your system has the "brains" to submit claims. If not, go shopping.

3. You need a clearinghouse. This could be through your PMS dealer or a direct connection.

Which claims cannot be submitted? Four years ago, when our office went on EMC, we submitted 12 percent of our total claims. In the last two months, we submitted 72 percent. Today, 150 carriers accept EMC. The rare and endangered few who do not will, and soon.

If X-rays are required (pre-auths or post-ops) your claims will be: 1.) flagged by your own software and held back for you to hand-submit, together with the X-rays; or 2.) will be returned to you in a flash, by the clearinghouse, along with corrections needed. Right now, 85 percent of all claims do not require X-rays.

Attached narratives must fit in limited electronic space, which means you learn to write tight. Useful idea.


There are many. Your practice will:

a. Save time. No pencils to push. No postal delay.

b. Save labor and postage costs. Isn`t it more important for receptionists to work with people than handwrite forms? Decision time, doctor.

c. Improve cashflow. When your money gets into your pocket 10 days earlier, that`s a profit.

d. Save error rejections. One-third of all dental-insurance claims are denied due to errors. You will learn immediately if a form is in error and can correct it at once.

The last 1,000 claims my staff submitted by EMC cost $600. Could we have hired an assistant to do them perfectly for $600? Not in this life.

When is the best time to start filing EMC? Now. Even if you have only a few claims. The office with fewer claims benefits more because there are often fewer team members to shoulder multi-tasks.

EMC is headed all the way!

- Currently, carriers lower some barriers that may delay hand-written forms because it is cheaper to pay a few extra claims than to ferret out a few rejects.

- No carrier now accepts CDR (computerized dental radiography) and electronic charts, perio or tooth, but they will be ready when you are.

- Ultimately, dentists will be paid by wire transfer, completing the wire circuit.

Today, Dr. Garblik states that his firm works with 114 dental vendors who send 1.4 million dental claims a month to ENVOY-NEIC. The wires are in place. Are you?

For further information call:

1. CPS, Claims Processing Services at 203-289-6090;

2. EIS, Electronic Insurance Services at 800-576-6412;

3. ENVOY-NEIC Corporation at 800-366-5716.

The author practices dentistry in Cedar Rapids, IA, in an electronic dental office. He has written three best-selling, practice-building books. He also lectures frequently on profit-building with dental computers. Address E-mail commentary to [email protected].

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