Dental Billing Services for Multi-Location DSO Claim Routing

Dental Support Organization or DSOs generally operate in a complicated administrative environment. This is because tasks like managing claims for a single claim is complicated enough. Multiply all that workload across different locations, and you have a complicated situation.

Each of the respective practices under the wings of a DSO come with their own details and complexities. If a DSO fails to acknowledge that correctly, then it is highly likely that the billing will take a hit. Therefore, it is important for these dental support organizations to look for professional help.

And that opens the door for outsourced dental billing services. These specialized services tend to help providers centralize billing operations. They tend to do that with the help of operational discipline across the billing journey. Therefore, being more than just clerical support to an organization.

Follow along to see how a Dental Billing Company can be helpful for multi-location DSO claims.

Understanding the Complexity of Multi-Location DSO Claim Routing

Most providers can think claim routing is as simple as choosing an insurance carrier from a billing menu. But the reality of the matter hits differently. For effective routing, one needs to present other interconnected details. Such as the details about the treating provider, billing entity, practice location, payer destination, and applicable participation arrangement.

A dental group that operates across several different states can have multiple tax identification details and legal entities. On the other side, some providers might participate with a certain payer in one location.

These payers can have a different enrolment arrangement when the location changes. Subsequently, certain practices might operate under acquired business names, but route claims through another corporate identities.

All of these create RCM challenges that are best addressed by professionally outsourced dental billing services. These services are not just taking care of the billing but can help a DSO delegate a lot of financial work. As a result, easing the work load for an already encumbered work force.

All these differences play a major role in complicating DSO claims significantly. Therefore, what a DSO needs is a clearly defined insurance claim route. This is something that dental billing outsourcing services excel in. They understand the organizations’ structure and individual requirements simultaneously. Therefore, working like a bridge connecting two billing entities.

What Dental Billing Services Bring to the Table?

The foremost thing that a dental billing company can bring to a DSO billing is centralization. It is very common for DSOs to manage claims according to the operating regulations of a region.

As a result, this changes how it handles the administrative of different dental claims according to local requirements. Therefore, this can create a sense of fragmentation in the work of DSOs that operate across different locations.

The challenge is that these differences are generally not that visible. They gradually become more visible as the damage starts showing. Some of the common ways this error manifests is when the claim begins accumulating in rejection queues. Or when the financial reports show a lower figure, what was estimated.

A centralized billing workflow of a dental billing company addresses this crucial issue. It establishes a common administrative standard. This does not take away from the provider’s visibility in any way.

It only ensures that every claim is handled in uniform fashion. The right biller can truly help DSOs create billing workflows according to different metrics. As a result, helping them keep tabs on the claims that the organization is sending out.

Related Reading: Dental Billing Services for Cross-Coding Claims

Key Factors That Determine Accurate Dental Claim Routing

Dental routing can be a daunting task as several data elements need validation. These elements determine whether the claim is processed correctly. Which in turn decides the overall payout.

Billing Entity and Tax Identification Number

One of the most common routing considerations for DSOs is identifying the correct legal billing entity. A multi-location DSOs function across several practices, that are bound by a single organizational structure. All the while maintaining their separate legal entities and tax identification numbers.

A centralized billing support along with a location database can help providers maintain these distinctions. The database can identify important details such as the legal entities, tax identification numbers, billing address, and associated payer relationships. Therefore, helping DSOs keep track of all the claims it is processing.

National Provider Identifier and Rendering Provider Details

The National Provider Identifier or NPI is another important component of dental billing. Providers across the USA use the NPI to identify themselves in applicable electronic healthcare transactions. Therefore, it is understandable why Dental Billing Services tend to be careful while handling NPIs.

Since DSOs work with multiple providers, identification has become crucial. The organization must clearly identify whether a provider is an individual or an organizational provider. These details need to be populated in the claim as per the payer’s requirement. This is especially important for organizations that work across multiple locations. Since one small mistake can render a claim or a group of claims unpayable.

Service Location and Practice Identification

Just as the provider identification is a pain point for dental billing outsourcing services working with DSOs. The service or the practice location is another important area of concern. This is because the physical location of the treatment needs to be distinguishable from the office where billing was done. This is especially relevant for the DSOs that operate across different offices in the same geographic region.

That is why professionally outsource dental billing vendors tend to follow a claim routing framework. Here is what the records must include:

• Practice name and service address.
• Associated legal billing entity.
• Applicable provider identifiers.
• Payer enrollment and participation status.
• Relevant practice management system identifiers.
• Corresponding electronic claim submission configuration

These details are crucial since they help identify where the claim has originated from. Subsequently, determining how it will be processed.

Building a Centralized Claim Routing Framework for DSOs

Even though we have been talking about centralization for a while, it is different than what moist people think. Centralization is not about routing every claim through a single generic workflow. Instead, it involves creating a standardized system that can effectively identify differences. Additionally, applying correct claim routing rules through controlled or automated review.

Develop a Centralized Provider and Location Registry

A central registry is the foundation for multi-location claim routing. The registry needs to be comprehensive and must include accurate information regarding key details. These include details about every participating practice, legal entity, provider, and the insurance relationship.

This registry needs to be updated on a regular basis and must reflect all operational changes. Which might further include new dentists, departing providers, acquired practices, etc.

A well-maintained registry helps DSOs to identify its relationships with different provider entities. A centralized database containing these details to reduce guesswork and help expedite the claim work.

Most dental billing services push for centralized tracking for the sake of convenience. It enhances accessibility to relevant information. Also preventing the recording of multiple conflicting versions of a single record.

Establish Payer-Specific Routing Rules

Different insurance carriers demand different claim submission workflows. While some accept electronic claims through a single designated clearing house. While the other might have a plethora of unique requirements regarding payer identifiers, supporting documentation, etc.

This is why dental billing outsourcing services that specialize in working with DSOs must maintain a payer routing matrix. This matrix must identify the following details:

• Insurance carrier and applicable payer ID.
• Accepted electronic submission channel.
• Relevant clearinghouse connection.
• Required claim information and documentation.
• Applicable billing entity and provider combinations.
• Rejection and acknowledgement of handling procedures.

This routing matrix might seem like a daunting task. However, it is very useful for distinguishing between payer entities, as and when required. In fact, experienced dental billing services can attest to the fact that similar names do not entail similar payers. These payers can have different submission workflows even if payers share brand names.

How Dental Billing Services Support the End-to-End Routing Process

DSOs manage a wide range of responsibilities. Therefore, it is common for such providers to outsource their billing operations to dental billing experts. Dental billers bring in their own billing expertise to streamline RCM functions.

They also bring in operational understanding and discipline when it comes to billing. Since all they do is billing so they bring in focused expertise unlike generic billers. Here is how a professional dental billing company can support end-to-end claim routing process effectively.

Patient Registration and Insurance Verification

The foremost area of concern for a professional biller is to begin where claims begin, the front end of the dental billing cycle. This stage of the process includes functions such as eligibility verification, scheduling, and coverage identification. A professional biller takes special cognizance of this stage as it decides the payout later on in the cycle.

For multi-location practices, the verification must also include details regarding the treating practice and the provider in charge. The billing partner in charge needs to be careful since the same insurance carrier might have different participation arrangements across locations.

This is why the internal team or the outsource dental billing company must never assume that applicable arrangements are similar. They can wildly vary across locations. This understanding becomes the cornerstone of correct dental billing routing.

Electronic Claim Submission and Clearinghouse Processing

Once a claim passes the internal validation, it is transferred to a designated electronic submission channel. Or in other cases, it is transferred to a clearing house. Upon receiving, clearinghouses perform all the applicable processing, before the claim is moved ahead.

Clearinghouses especially become relevant for DSOs that are currently managing claims across different payer entities. They ensure that every claim is routed correctly, according to local regulations and requirements.

Then again, a clearinghouse cannot compensate for every error. Yes, they can identify areas that need closer addressing and adjustment. But they cannot guarantee payouts. If details regarding the billing entity, provider information, etc., are incorrect, then the claim can be held up. This is the task of a dental billing company and its denial management team.

Payment Posting and Reconciliation

The routing process does not end when the insurance receives the claim. Given how DSOs work with multiple claims, the work begins after the adjudication process is done. After adjudication, the organization must identify the correct practice. Furthermore, the patient account that is associated with the payment.

Centralized payment posting makes things easier. This helps the organization to easily track payments across the location. However, payment posting also needs to retain information that is unique to the claim. Which includes the original location of service and the billing entity.

Electronic remittance information can be helpful in this situation. It can help the dental billing company or personnel to reconcile payer responses with the submitted claims. The right biller would not only submit but also compare the differences between the reimbursed amount and the expected payment. This helps in identifying underpayment.

Related Reading: How Dental Billing Companies Improve First-Pass Claim Acceptance Rates

Should DSOs Outsource Dental Billing Operations?

Dental billing services can bring a lot to the table, but the question lingers. Should a DSO consider outsourcing the billing vertical, and the answer to this question is a yes. Even though established DSO have their own billing team, a practice that wants to scale might need extra support.

Professionally outsourced dental billers can help scaling providers with the breathing room it requires to spread their wings. The best part is that a scaling DSO provider does not have to worry about hiring more individuals. A professional biller can turn this entire thing into a flat cost that the provider can bear.

Then again, outsourcing does not mean that a provider is submitting the internal governance as well. The right approach in this situation is to retain control with the help of legally bound contracts. This contract can easily highlight the areas of ownership between the provider and the billing entity, as well as the escalation pathways for when things go south.

How Can SunKnowledge Help You?

Multi-location DSO claim routing is not as easy as it might sound. It requires a coordinated approach to provider identification, billing entity management, payer configuration, etc. Therefore, it requires a certain level of expertise and experience.

As dental organizations scale, the requirement becomes all the more blatant. Therefore, the only solution to this is to bring in the right dental billing company like SunKnowledge. We, as one of the leading dental billing services, can take over the billing side of the organization and ease operational pressure. Our billing experts offer robust support and can help your organization remain compliant and ready to scale.

The best part is that we offer our expertise on this matter for a flat fee. Something that sets us apart from other dental billing services. Therefore, pay a flat fee and watch our experts with 15+ years of experience, upgrade your RCM. Get in touch with our experts today!

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