Claims and Collections: Create a Process That Benefits the Practice and Patient

In a world that seems to be constantly creating new challenges, one old nemesis remains the same: insurance reimbursement. Like all businesses, dental insurance is concerned with profit, which means maximizing income and minimizing payouts. Timely, painstaking claims submissions and management are therefore still critical when working with insurance companies to get the most money possible for the work done. However, you can make the process more efficient and help alleviate patient frustration by creating workflows that include software tools that streamline the claims and collections process, hiring insurance negotiators and working with patients (sometimes creatively) to address their needs.

Create workflows

The key to an efficient claims workflow is a formal process developed with the practice team. Consider establishing these components into your process and adapt them as necessary for your unique practice needs.

  • Insurance coordinator. If possible, hire an insurance coordinator whose only role is working with insurance companies, talking with patients about eligibility, and updating processes as needed.
  • Eligibility. Establish eligibility before treatment begins and walk the patient through what is and isn’t covered. Surprise bills will only create tension between you and your patients.
  • Processing steps. Outline claims processing steps that include how and when claims are submitted and tracked, how often the insurance coordinator follows up on them, how payments are entered into your system and when statements are sent to patients for payment of remaining balances.
  • Education. Find educational opportunities for your team to ensure they’re knowledgeable about dental insurance and the claims process, including new and updated CDT and ICD-10 codes. Your insurance coordinator should answer any detailed questions, but the rest of the team should be able to talk about your process without hesitation.

Software tools

Leveraging your practice management system with insurance claims software that can instantly confirm current benefits, codes and copays can help lighten the claims burden for team members and increase efficiency by putting answers to common insurance issues at their fingertips.

The Eaglesoft Insurance Suite, for example, includes the ability to address patient questions about eligibility and submit complete, accurate electronic claims and attachments. The software also provides status reports on claims submissions, electronic remittance advice and visibility into rejected claims, allowing them to be quickly corrected and resubmitted.

Professional negotiators

In some instances, it may be worth negotiating with insurance companies for higher fees. However, this can be a time-consuming endeavor (especially if you don’t have an in-office insurance coordinator), so consider enlisting a third-party vendor to negotiate on your behalf. Professional insurance negotiators have direct access to their counterparts in the insurance industry, know the changing insurance landscape and are aware of how often different payers are willing to negotiate contracts. They also have the advantage of being neutral and uninvolved in any ongoing claims disputes, which can help keep communication clear and frustration-free.

Working with patients

Collaborating with patients can help make the claims and collections process go more smoothly. To make this more of a team effort, take steps to ensure transparency and cultivate patient loyalty.

Be transparent

This is where the eligibility component of your claims process comes into play. No one likes to receive a “surprise” bill, and unexpected fees can damage a patient’s trust in the practice. Be transparent about treatment costs and payment options, even for what may seem like a relatively minor procedure.

Providing all patients, new and existing, with a copy of your financial policy also can help avoid misunderstandings about when payment is expected, and what payment options are available to help with significant charges. This policy can be sent to all patients periodically, as well as presented directly when a patient sits down with your treatment or insurance coordinator to discuss pretreatment estimates. This conversation also should clearly lay out the expected payments due at each appointment. Automatic payment plans may be helpful for some patients.

Another option is third-party financing, which allows the practice to get paid in full and the patient to pay in installments, while leaving the management of those installments to someone else. Or consider offering a “courtesy fee adjustment” (a discount by another name) for payments made in full up front. Some practices also may find it beneficial to always collect 20% of fees or insurance responsibilities at the time of service.

When creating or reviewing a financial policy, remember that having a few flexible payment options can make it easier for patients to agree to more extensive treatment, but too many can make the policy confusing.

Cultivate members

The membership plan model is starting to make some inroads in dental care, where each individual practice can design its own plan and set its own fees. Not only does this concept avoid the hassle of dealing with insurance claims – the patient pays the practice directly – it also may foster a sense of patient loyalty to the practice because they’re a “member.” The ADA offers an on-demand webinar, “Increase Value in Your Practice! How? Start Your Own Dental Plan,” and a toolkit to help dentists start the process.

Don’t forget the basics

Of course, all the payment options in the world can’t eliminate the need for effective, diligent, basic billing practices, such as:

  • Put a due date on all bills. Phrases like “Payable on receipt” or “Net terms 30 days” are too easy to gloss over, deliberately misunderstand or simply set aside for later.
  • Add a finance charge for late fees.
  • Follow up with polite, professional phone calls by the financial coordinator for late payments.
  • In an era when “contactless” transactions have become the norm, one standard billing practice – sending invoices by snail mail and receiving payment the same way – might be due for replacement. Electronic billing saves time and postage, and patients can simply log in and click to pay.

Keep communicating

Communication and transparency are two keys to practice efficiency and patient and staff satisfaction. Work with patients to ensure that their insurance plan information is up to date, check patient insurance eligibility before beginning treatment and provide payment options if necessary. Invest in technology and tools that make your ability to take these steps as easy as possible. And don’t ever let a patient feel surprised by a bill or your financial policy. When you and your team work with patients, you create practice atmosphere of support and patient well-being that’s sure to promote a collaborative relationship.


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Unlock the PPO. Hiring a negotiations pro.

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This article originally appeared in Advantage by Patterson Dental. Read the digital publication here.