Insurance Worksheet Instructions

Insurance Worksheet Instructions

Revised 9/22/2018

Purpose: To correctly use our Insurance Verification Worksheet ensure we get all the correct information to financial arrange a patient.

Note: Every new patient with insurance needs to have the insurance worksheet completed and scanned in his or her chart.

Steps:

Complete the Top portion of the form with the patient information gathered from the patient.
Make sure to confirm the Payor ID – this is what allows us to send electronic claims and allows us to get paid for services. VERY IMPORTANT!!
Check Primary, Secondary, or Tertiary. If the patient has more than one insurance complete a separate form for each Insurance Company
If the patient has more than one insurance be sure to ask if it is non-duplicate. (This is very important because if an insurance is non-duplicate it will not pay if the primary insurance covers the same %). If the patient only has one insurance circle N.
If plan has a waiting period circle Y and specify when the waiting period ends. If certain procedures are subject to this waiting period you must enter them as covered 0%. Create an alert for patient so insurance can be re-verified after waiting period is over.
Determine if the insurance is Calendar year (coverage from January to December) or if not document the Month the policy starts (ex: June or Oct).
Confirm the patient’s maximum benefits and deductible. Document if the patient has used any of the benefits for the period in question, as well as the deductible. (This is important to financially arrange the patient correctly). Ask if yearly max applies to preventive claims and what the deductible is applied to.
Document the percentages covered for Preventive, Basic, Major, Perio, and Endo services. Confirm if Oral Surgery is covered under Basic or Major. Be sure to ask at what percentage Sealants, Build up, Onlays are covered.
Document frequency limitation and age limitations for fluoride and sealants.
Confirm last date of service for preventive services and sealants if applicable.
Document replacement limitations for dentures/partials, bridges, and crowns (This may be 5 to 10 years and is VERY IMPORTANT!!).
Notate if crowns or fillings on posterior teeth are downgraded.
Confirm frequency limitations for Cleaning, Bitewings, Perio SRP, Perio Maintenance, Exams, and PAN/FMX.
Document if prophy and perio maintenance are combined and applied to limitations for cleanings.
Confirm if the patient’s policy has a missing tooth clause. This means that the insurance will not cover to replace an existing tooth that was extracted before the start of the policy. VERY VERY IMPORTANT!!
Using the codes forimplants, bone grafts, nitrous, and occlusal guards confirm if covered or not. Document percentage if applicable.

NOTE: Once the patient’s insurance is confirmed and the Insurance Worksheet is completed for each insurance company, transfer information into practice management software and Scan the Insurance

Worksheet in with the faxed copy of benefits from the insurance company. Label correctly for each insurance.