MBSAP DENTAL CLAIMS ADJUDICATION SERVICES
With an impressive track record, we are the most sought-after dental claims adjudication services in India. Our claims’ processing expert negotiators strive to rectify errors, workout your denials and help with re-submissions. We explain all the details in an understandable manner all the while keeping you informed about the entire dental claims adjudication process. Mbsap your dental claims adjudication services to us will have you stress-free.
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Assorted Dental Claims Adjudication Services We Offer
Over the last 22 years, Mbsap , smoothly and efficiently handles dental insurance claims processing. We are, without a doubt, the best dental claims adjudication service provider in India. Here are some of the major services that we are pleased to provide –
The accuracy and extent of the insurance coverage for a dental procedure is evaluated. These criteria are used assertively for deliberations so that you get the maximum benefits of the claim amount especially in cases where the insurer wants to minimize the claim value.
A detailed and comprehensible explanation of remittance advice is provided for your perusal. For secondary and tertiary claims, we mandatorily include the following information –
- Payer Paid Amount – The reimbursement made by the insurer
- Approved Amount – This indicates the total claim amount approved
- Allowed Amount – The amount of total claim value permitted by the insurer
- Covered Amount – The amount of total claim value covered by the payer
- Discount Amount – Primary payer amount or adjustment as per terms of the insurance
- Patient Responsibility Amount – Amount for which the patient is responsible for. This includes co-payments, deductibles and co-insurance payments
- Dental Adjudication Date – The date the claim was adjudicated and/ or paid in part or full as per the policy criteria
We gather all data such as dental procedure details, bills, invoices, statements etc. The documentation is assessed, and dental procedures are investigated thus ensuring if the claim is legitimate. We thoroughly scrutinize the terms and conditions of the policy. We alert you of the slightest suspicions detected or any uncalled- for complications that arise. All fraudulent and lapsed claims are flagged off right from the start.
It is one of the major reasons for claim denial. Duplicate claims may be submitted for several reasons like if the payment wasn’t received even after assurance, lack of coding and/ or billing knowledge of various health plans or re- submission of the same claim after adding new information. We ensure that no such administrative errors occur during our processing.
All applications with incomplete details, mismatched coded, invalid documentation are electronically (and sometimes manually) weeded out once entered the billing software. Approved documents are cross-checked for compliance as per the insurance payer’s payment policies. All approved claims that pass this stringent step are then issued a remittance advice statement.
We precisely extricate data components from raw claims. This reduces backlogs and delays. We handle is in an efficient, compliant and an accurate manner.
Our latest dental claims adjudication software allows for enhanced transaction processing. With automated operations for verifying data entry for claims adjudication, enrolments, eligibility criteria, billing etc. This accounts for speedy processing and high- accuracy of the entered data.
We are equipped with complete details of Current Dental Terminology (CDT) for oral health and dentistry maintained by American Dental Association (ADA). We also have extensive knowledge of all dental codes required to code each dental procedure(s) for dental insurance plan submissions.
All insurer information is collated after an intense background check and we have thorough knowledge of all the terms and conditions of all their policies. We can help you decide on which dental insurance provider for in the future to best suit your needs.
With a systematically developed process management method we ensure that no claim is denied or must be resubmitted. Hence no delays can be encountered in the dental claims process. If your claims are wrongly denied, we handle the application procedure as per our methodology and ensure that the scales are tipped in your favor.
Here we ensure that the full right to payments is received as per the policy entitlement. We submerge ourselves and go through great lengths to intercede and overturn any obstacles.
We compute the claims amount. We notify you of all details on co-payments options, deductibles, as well as insurance plan exclusions so that you are prepared beforehand of the reimbursement amount that you will receive.
We thoroughly scrutinize cases where a claim is down coded- wherein the claim is adjudicated in a manner that reduces dental procedure codes to a lower- cost code. In such cases, we ensure that you are provided with the pay- out that you deserve. We evaluate cases of bundling wherein similar dental procedure codes are collated or grouped together resulting in combined submitted charges. We make appeals if we find the reimbursement amount reduced in any such instances.
For adjudication based on benefit, each claim is scrutinized and adjudicated as per the advantage it provides for a dental procedure and the reimbursements released as pre- decided by the claim. We determine the accuracy, time-limit and fairness of the remittance as promised by the insurance company.
You will be notified at every stage of the progress of your application via online tracking of claims application. This can be assessed by you at any given time. This is crucial so that we quickly rectify any corrections so that the claims are swiftly processed.
Any denied claims are re-adjudicated with the help of relevant documents recovery. Claims are then resubmitted for approval to your chosen dental insurance company and guaranteed that a settlement is reached at the earliest.
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