An introduction to eClaims and real-time eligibility

By Elden Rice, DDS, and Domenic Farnocchia, Concierge

By Elden Rice, DDS, and Domenic Farnocchia, Concierge

At one time, my dental practice used a system of hand-written claims that were mailed to insurance offices. This often resulted in lost X-rays and wasted time. At the time, we were taking traditional film X-rays, which would subsequently be lost even if they were stapled directly to an insurance claim. At this point, what can you really do? You have no choice but to have a patient return for new X-rays. This wastes staff and patient time, and can damage your relationship with the patient.

In 2003, electronic claims (eClaims) became a reality through the use of new practice management and clinical software from Patterson EagleSoft. These eClaims are very efficient because of the software’s end-of-day reporting capability. With just a couple of clicks of the mouse, claims are submitted We can then print a report that includes submitted claims, any problems associated with current claims, and all prior claims.

Patients see the benefits since claims are expedited. This speed is valuable to all involved. The patients quickly know where their account stands, and know if anything needs paid on their account. There is no limbo time for a patient. Knowledge is power. Being able to submit claims quickly and easily, with wonderful tracking capabilities, gives patients peace of mind.

Earlier this year, my practice began utilizing a new software feature called real-time eligibility. This feature allows a dental staff to access the level of benefits for specific patients, returning the data to any PC in the office in mere seconds. This allows the doctor and patient to discuss treatment options. Patients feel more comfortable knowing what their insurance benefits will cover. This instant gives the staff more time to explain treatment, and more time for a patient to understand what the treatment process will involve. There are fewer surprises.

The benefit is great for the front desk, too. Front-desk staff can access and print a patient’s level of benefits and account information, such as group number and coverage. Now, when a patient comes to the office, we are not spending valuable time on hold on the telephone with insurance carriers.

So what do these electronic insurance benefits really mean to a dental professional? It’s a time benefit. The office is more efficient. There is less waiting time to find out about a patient’s insurance eligibility; less time completing, submitting, and tracking insurance claims; and more information in your hands at a faster rate.

About the authors: Dr. Elden Rice has been practicing for 15 years and has used Patterson EagleSoft practice management and clinical software for five years. Three years ago, he implemented digital radiographs and CEREC technology. Domenic Farnocchia, Concierge, has worked at Dr. Rice’s dental office in Santa Rosa, Calif., the last two years. He has served as a customer serice specialist for several Fortune 500 companies. Reach him at Domenic@samedaydrowns.com.

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