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Outsource Dental Claims Adjudication Services

Dental Claims Adjudication Services

We extensively review and identify mistakes in claims before submission to speed up the settlement of your claims. Our dental claims adjudication services start at just $4 per read

If your company is suffering from low productivity from failing to keep up with the dental claims adjudication needs, it's a sign that you need to outsource dental claims adjudication services to experts who have been providing these services for years. At Flatworld Solutions, we are a team of experts that has been working for almost 16 years in helping clients fight fraud and grow revenue through highly efficient dental claims adjudication services.

Our team of medical claim examining experts are current with the rulebook and regulations of the adjudication practices. We scrutinize and analyze claims, whether manually or electronically submitted, to ensure that there are no inconsistencies or errors. We check the codes, patient's information, and have an eye for errors and duplicates that may cause claim denial or delay in passing the claim. This makes us the best dental claims adjudication service provider for both big and small dental clinics and hospitals.

Dental Claims Adjudication Services We Offer

Flatworld Solutions offers several dental claims adjudication services with the help of skilled teams of claim examiners who specialize in both electronic and manual dental claims adjudication. We have been partnering with hundreds of hospitals and insurance companies globally, successfully fulfilling dental claims adjudication needs of countless clients. Our expert claim examiners keep abreast of big and small changes and advancements in the industry to ensure they provide the best dental claims adjudication services to a countless number of clients who trust us. Following are the dental claims adjudication services that we offer -

  1. Determination of Dental Claims Value

    Determination of Dental Claims Value

    We will thoroughly assess the submitted claims to ensure that the dental claim value submitted matches the rates of service levels.

  2. Determination of benefits

    Determination of Benefits

    We will analyze the claims to find out if the EOB sections are accurate if it needs correction.

  3. Verification of Raw Dental Claims Data

    Verification of Raw Dental Claims Data

    We will assess your raw claims data to ensure coding is correct and there are no errors that may have inadvertently occurred during coding.

  4. Insurance Eligibility Verification

    Insurance Eligibility Verification

    We will check if the patent that availed the treatment was eligible for the dental procedure.

  5. Duplicate Dental Claims Investigation

    Duplicate Dental Claims Investigation

    We will discover duplication of claims data that might prevent the provider from receiving the full amount from the insurer. We will flag the duplicates and make necessary corrections.

  6. Diagnostic Code and Patient Data Review

    Diagnostic Code and Patient Data Review

    The diagnostic codes and patient data is thoroughly verified to ensure it is 100% accurate and error-free.

  7. Dental Claims Validation for Fraud Detection

    Dental Claims Validation for Fraud Detection

    We have investigators who discover deliberate attempts to overbill. They ensure that the claims aren't manipulated to extract more money than the provider is eligible.

  8. Evaluation of Provider Details

    Evaluation of Provider Details

    We scrutinize provider details to check if they are tied up with the insurer and if they are licensed to operate under the insurer's guidelines.

Dental Claims Adjudication Process We Follow

Our team of experts at Flatworld Solutions knows the intricacies involved in the process of dental claims adjudication. We follow a systematic protocol to ensure that our operations are accurate and highly precise. We're equipped to handle complications, if any, at any of the stages throughout the dental claims adjudication process and this helps us offer you efficient services well within the decided timeframe. Here are the steps that we follow to provide you the most reliable dental claims adjudication services in the industry -

 

01. Initial Processing Review

Our experts initiate the first step in which we check the dental claims to detect any errors or missing information. When the insurance company denies the claim for one of the reasons given below, corrections can be made in the claim accordingly and the claim can be resubmitted.

  • Error in the patient's name
  • Incorrect patient gender
  • Error in entering a place of service code
  • Incorrect service date
  • Missing or incorrect code of diagnosis
  • Incorrect subscriber identification number
 

02. Automatic Review

In the second stage, an automatic review is done to check the information about the payment policies. Our experts use their skills along with electronic systems to identify the following issues -

  • Patient's eligibility on the service date
  • Invalid or missing precertification
  • Invalid or missing authorization
  • Submission of duplicate claims
  • Crossing the filing deadline
  • Invalid code of diagnosis or other procedures
 

03. Manual Review

This is a common process wherein doctors and other healthcare professionals compare the claim and medical documentation. While we use the latest systems and tools to check claims, our dental claim processing experts check the claims manually, especially when the medical procedure is not listed.

 

04. Payment Determination

The three types of payment determination that we use at Flatworld Solutions are as follows -

  • Paid - When the dental claim is considered to be paid, the insurance payer directs if the claim can be reimbursed.
  • Denied - When the dental claim is considered to be denied, the payer directs that the claim is non-reimbursable.
  • Reduced - If the amount that is billed is on the higher side for the diagnosis, the procedure can be down-coded to a lower level by the claims examiner.
 

05. Payment

We then proceed to the final stage of the dental claims adjudication process wherein the payment is submitted to the office. This is called the explanation of the payment and this includes info ranging from the explanation for the reduced payment, denial of payment, adjustment, and much more. Other information includes the amount of payment that is allowed, paid, covered, approved, etc.

Other Services You Can Benefit From

Why Outsource Dental Claims Adjudication Services to Flatworld Solutions?

Flatworld Solutions has been the preferred destination for countless hospitals and other medical practices, like dental clinics for comprehensive medical billing and other healthcare services. We work with a team of efficient dental claims adjudication experts who pioneer in using the latest tools and technology for the same, providing top-notch dental claims adjudication services. Our experience and commitment to fulfill the needs of both big and small practices help us be the best dental adjudication service provider. Here are the benefits of choosing Flatworld Solutions for dental claims processing services -

  • HIPAA Compliant Service Providing Company

    All of our services and processes are in strict compliance with the HIPAA regulations. We ensure that we adhere to the rules, regulations, and laws about the services we offer.

  • 100% Data Security

    When you share your personal information and documents containing the same, we treat it with the utmost confidentiality. We have restricted employee access to the client info, and we ensure complete data security with the help of our latest security systems and security policies that are legally binding.

  • ISO Certified Company

    Flatworld Solutions is ISO 9001:2015 certified company which gives you standardized quality assurance. Our services and processes pass through various stages of quality checks to ensure that our services have high precision and are free of shortcomings.

  • Affordable Services

    We provide customized pricing solutions to our clients to offer them the freedom to choose the dental claims adjudication services that they need so that they only have to pay for the services that they opt for. Our prices are suitable for both big and small-scale health practitioners.

  • Experienced Dental Claims Adjudicators

    What adds to the decades of experience that Flatworld Solutions holds is our experienced dental claims adjudicators who have been a part of the industry for a significant number of years. Having catered to a large number of dental practices, we have gathered unmatched insight into the dental claims adjudication services that help us provide services that are nothing but excellent.

  • Quick Turnaround Times

    Our expert dental claims adjudicators, with the help of our state-of-the-art infrastructure and cutting-edge technology and tools, ensure that the projects are completed well within the timeframe that is decided, promising quick turnaround times.

  • Scalability

    We have the required manpower, resources, and current technology when there's a need to upscale the project based on the client's unique business requirements at any point in time. We make sure the project is completed and delivered within the stipulated time irrespective of how big or small the demand is.

  • 24/7 Assistance

    Our team of customer care executives is available round-the-clock to assist with any client queries. You can reach our team regardless of your time zone or location, and our team will revert in less than no time.

Client Success Stories

Demographic and Charge Entry Using Kareo Software

Demographic and Charge Entry Using Kareo Software

A reputed Houston-based healthcare client was in search of a partner to help them process 17000+ claims in a month. Our team offered high-quality charge entry services within no time.

Read more
FWS Provided Healthcare Accounts Receivable Services

Healthcare Accounts Receivable Services

A top AR needed a billing partner to handle their account receivable services and streamline cash flow. Our team undertook the project and ensured a steady stream of revenue.

Read more

Outsource Dental Claims Adjudication Services to Flatworld Solutions

Testimonials

Justin, I just wanted to say thanks for doing such a great job with my pre-writing and jellybeans. I am very satisfied with your work and feel that it has been getting better and better. It has helped me immensely and I appreciate it.

Doctor,
Thyroid and Endocrine Specialists, Houston
More Testimonials »

Dental practitioners might find it challenging to take care of the dental claims adjudications, given they have to focus on the core operations, providing services that are best to their potential. As a practitioner, when you divide your attention and devote it to dental claims adjudication, it can cause you a lot of stress and might affect your efficiency, not to mention dental claims processing services require skills and knowledge. Outsourcing your requirements to the adjudication of a dental claim service providing company helps you reduce the burden and focus better on your core competencies. Flatworld Solutions is a client-centered company that provides a variety of healthcare services, including dental claims adjudication services. If you're looking for services that are affordable and efficient at the same time, we become a natural choice for you. What makes our services exceptional is our basic values of transparency and giving our hundred percent to fulfill our client's needs with utmost diligence.

Get in touch with us now for the best dental claims adjudication services that help you run your healthcare practice better.

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