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When you picture how experts in dental billing and accounts receivables spend an average week in November, does it include snorkeling and gourmet lunches? 

No? 

Maybe you’ve been spending your vacations with the wrong dental billing experts. (Or not enough in general). And maybe it’s time that you caught up with how we spent a few days in November in late 2022.

The Versa Team’s First Annual Company Retreat

Last November, the Versa team packed up and went to Cancun, Mexico for something of a working retreat. This was our first annual company retreat—but based on our experiences, it’s fair to say that this isn’t a tradition that we plan on going away any time soon.

It started on Wednesday, November 9th. Yes, there was some work involved. Emails, claims, and scans—if you’re in the dental billing industry, you know the drill. (Sorry. Little bit of a “dental billing” pun for you. Can you see what a good mood we’re in?)

We met up at the Hotel Marina El Cid Spa & Beach Resort—which was every bit as swanky and luxurious as it sounds—and after a brief walk, all caught up in the lobby. From there, it was time for a team lunch at La Alhabmra at the resort, followed by a little team-building. 

(Note: how do we define “team building” at Versa? Beach volleyball. Fancy drink competition. Water sports. ‘Nuff said?)

From there, there was an ample supply of free time, which is our favorite kind of time, and an optional team dinner. But since we wanted a relaxed atmosphere, we kept that dinner fully optional—after all, there’s nothing like a little “me” time to cap off a day in paradise.

“Is This What You Call Work?”

Thursday was the second “main” day in Cancun. This brought another work session—emails, claims, scans, easy-peasy. Thanks to a hotel suite with WiFi packed in, it was easy to do our work remotely. It’s a funny feeling looking out onto the blue waters and skies of Cancun while getting your dental billing work done indoors. 

Kind of makes this whole “dental billing” stuff kind of easy, to be honest.

But Thursday wasn’t going to be just another day at the office. After the a.m. work session, we went on to another team building activity. Drumroll, please…

…are you drumrolling?…

…a session of catamaran sailing and snorkeling touring—with an open bar included. 

After all, nothing quite builds a team quite like sharing a ship together. You learn how to navigate together, how to handle a catamaran, how to—okay, maybe it’s not exactly all business, but it’s definitely a great way to bond.

Thursday also brought a lot of rest and relaxation, with a long free time session and a farewell dinner. That brought us to Friday—the travel home day. And like it or not, there does eventually come a time when you have to go home.

What We Did in Our Winter Vacation

What can you say about our Cancun trip? That’s not a rhetorical question. You can say all sorts of great things. Not only did our team come closer together than ever, but we had some of the best food and drink that side of the border. 

The food was terrific. Everything from authentic French fine-dining to the Pizzeria Il Peccato, an Italian joint. Mexican antojitos, fresh seafood, an Asian-infused menu at Mercado de Delores—you can practically hear the sizzling even now.

Would we do it again? Absolutely. Of course, business back here still beckons us home. But there’s nothing like getting out of the office and doing work in a completely different location to recharge the batteries.

Was it the average week in dental billing? Maybe not. But at Versa, we were never concerned with doing things the average way. 

And the same applies to the work we do at the office. Versa Solutions’ work hard, play hard mentality shows up in the high standards in everything we do. Even if it’s just an ordinary week in November. 

Dealing with insurance companies can be painful. Even when everything is filled out correctly, a dental insurance claim could still be denied for a simple mistake. Something as minor as a missing address of a patient could throw a wrench in the entire claim process. Thankfully, most denials are due to 4, relatively easy to fix, reasons. It is easier to spot these mistakes once you know what to look for. To help your dental insurance claims go as smoothly as possible, be on the lookout for these potential issues:

1. Non-Covered Services

It can be difficult for patients to understand the ins and outs of their dental insurance. The verbiage makes it challenging for someone not in the dental field to know how often services are covered. A dental claim can be denied due to limitations or for too frequent visits.

What can be done?

The best way to guard against this denial is to circumvent it before services are performed. The dental practice must verify insurance benefits to ensure the insurance policy covers the treatment.

2. Missing or Incomplete Information

The insurance company could require additional information before agreeing to cover the treatment. They want to ensure that procedures are not performed frivolously. It is important to submit any and all documents supporting the claim in the first go around, otherwise, the claim could be denied.

When submitting a dental claim, a detailed narrative must also be submitted. Using a general narrative for multiple patients is unacceptable per insurance standards and will result in a denied claim.

What can be done?

This is a simple and easy-to-correct mistake. The dental office must gather the missing information to submit to the insurance company. Once the documents have been submitted and attached to the claim, the claim will be reprocessed. Although this is an easy denial to fix, it can still eat up man hours to find and submit the missing information. Ensure that all necessary documents are properly submitted the first time around to save on staff work.

3. Criteria Not Met

If a dental insurance company believes that a patient did not meet the criteria for a procedure, they could deny the claim. The onus is on the dental office to prove that the patient met the criteria for the treatment and was covered by the insurance policy.

What can be done?

Insurance companies can be intentionally vague with the reason for a dental claim denial. Suppose a “criteria not met” denial comes across your desk. In that case, there must be a follow-up with the insurance company to determine what the criteria are and what other information they require. Using this information, documents can be gathered and attached to the claim for reprocessing.

4. Core Build-Up (Code D2950) Denied

A build-up involves restoring a tooth that lacks the structure to hold a crown. Teeth that require a build-up procedure typically lack over 50% of their form. Often, an insurance company will balk at this code because they view it as inclusive to a crown procedure.

What can be done?

If a build-up procedure was conducted independently of the crown or bridge, the insurance company must be made aware of the crown or bridge seat date. Additional information may also be required, such as x-rays or proof of the tooth’s condition. As always, a detailed narrative will assist in pushing the dental claim through.

Additionally, Cigna uses at least two denial codes for D2950; PB & NT.

PB: Benefits are not provided for this service as it is considered to be a part of, and inclusive to, the primary service performed.

NT: Your plan does not provide benefits for this service.

If a build-up is denied with code NT, it can be treated as a non-covered service by billing the patient the UCR fee. If a build-up is denied with code PB, call Cigna to provide the seat date of the crown. That is usually all what’s required to overturn that denial.

Versa Solutions can help find a list of denied D2950 procedures in your software and overturn these denials. Ask us how!

Say Goodbye to Denials

If the dental insurance company denies a claim, it is usually for one of the above reasons. Although it can be frustrating dealing with vague denial reasons, submitting all the necessary paperwork the first time around can make the process easier for everyone involved. Use this information to your advantage to stop claim denials and receive the money that your dental office is rightly due.

We’ve spoken with many, many, MANY dental offices and found that most are only collecting 60-80% of the pay they should be receiving.

Ouch!

If you are in this camp, you work wayyy too hard and wayyyyy too many long hours to only take a fraction of what you’re owed.

But who has the time to clean up your A/R, spend hours on insurance billing, or talking to insurance companies over the phone?

Because we’re sure your office is swamped with mountains of other important things to do like scheduling, patient care, dentistry, the patient experience, and more.

And that’s where we step in…

Our services are 100% virtual, so you won’t have to worry about us taking up more of your time or getting in the way of other important jobs in the office.

But just because we’re virtual doesn’t mean we’re not hands-on — we assign a dedicated billing specialist to your specific office to handle: 

✅ Claims Submission

✅ Insurance Payment Posting

✅ Appeals Submission

✅ Audit Accounts

✅ Patient Statements

✅ Patient Billing Calls

✅ And more!

Want to take that 60-80% to 100% in a cost-effective, time-saving fashion?
Schedule a 15-minute call with us to find out if what we do would be a good fit for your office!

Some new insurance updates that affect claims submission, EOB management, and payment reconciliation have come to light. To help you navigate this new dimension, we bring you key updates you should know about. This will help you make informed decisions with your claims and act quickly where necessary. 

We’ve highlighted some important information for you below. 

Catch Up on Insurance Updates

As of January 1, 2023, Avesis stopped being the administrator of dental benefits for Molina Healthcare of Illinois Medicaid plan and Molina Dual Options Medicare-Medicaid plan in Illinois. However, Avesis will still process all eligible claims with dates of service on or before December 31, 2022. 

You must note the important filing dates and their deadline to ensure you stay compliant. 

Molina Healthcare of Illinois Medicaid plan Deadlines

• File and correct an initial claim 180 days from date of service
• Correct a claim 90 days from the last EOB date after the timely filing limit has expired
• Appeal a claim 90 days from last EOB date
• Submit a claim with primary EOB 90 days from date of primary payer’s remittance advice

Molina Dual Options Medicare-Medicaid plan in Illinois

• File and correct an initial claim 365 days from date of service
• Correct a claim 90 days from the last EOB date after the timely filing limit has expired
• Appeal a claim 30 days from last EOB date
• Submit a claim with primary EOB 90 days from date of primary payer’s remittance advice

When billing Avesis for claims with a DOS before December 31, 2022, you can file claims through the following three formats.

• The first format is going through Avesis secure web portal. Proceed to the portal and follow the prompts to bill Avesis. 
• Clearinghouses: Avesis has three clearinghouses through which you can file your claim. These include Change Healthcare (Payer ID: 86098) (1-888-255-7293), DentalXChange (Payer ID: 86098) (1-800-576-6412), Tesia (Payer ID: 86098) (1-800-724-7240)
• The final option is sending a completed paper ADA claim to:

Avesis Third Party Administrators, Inc. 

ATTN: Dental Claims

PO Box 38300

Phoenix, AZ 85069-8300

2023 Changes Avesis Billing

Starting in January 2023, you will need to use Payer ID AVS02 (dental) to avoid claim rejections and payment delays. Your billing team at Versa Solutions will make the necessary changes in your software for clean claims submission.

Speak With Our Professionals

With new updates concerning insurance and billing, we understand you may have concerns and questions you need answers to. At Versa Solutions, we’re always available to take your questions and provide you with practical answers that help solve your dental billing needs. 

Our goal remains to help you create a predictable cash flow so that you can focus on offering premium dental care without worrying about your A/R. We’ll help you navigate your billing systems to ensure you don’t miss out on cash flow. 

You can always reach out to us for any billing questions you have. We’re always happy to help!