Working the treatment accepted last year and never scheduled
Diagnosed, presented, agreed to in the chair, and still sitting on the unscheduled list eleven months later. Producing the list is trivial, because the plan already lives in the practice system with a status and a date on it. Ordering the list is the part with judgement in it. What remains of the annual maximum, whether a frequency date has reset, whether the plan year turns over in January or on the anniversary of the hire date of the subscriber. Some of that comes back on a 271. Much of it does not.
Electronic eligibility answers whether a patient is covered, and then somebody opens the payer portal anyway to find out what is actually payable.
There is a mandated electronic standard for eligibility, and it works. It confirms that a plan is active. What it routinely omits is the detail the front desk actually needs: frequency limitations, waiting periods, alternate benefit provisions and remaining annual maximum. That gap is the origin of most manual verification in this sector.
- Open Dental
- Dentrix
- Weave
When this is the wrong thing to build
Pick something else if treatment is mostly single visit and completed the day it is diagnosed, or if the unscheduled list has never been cleaned, since a list still holding plans the patient declined out loud will generate outreach that reads as pestering.
The constraint that shapes it
A practice is a covered entity, and any vendor that creates, receives, maintains or transmits protected health information on its behalf is a business associate, which requires a written agreement in place before any disclosure. More on how this sector works.
A list of things that are missing, worked until it is empty. Read what this shape is, or start from one of these.
- Chasing a compliance file to complete
- Chasing a referral fee through to a closing you cannot see
- Asking for the replenishment before the retainer runs to zero
- Chasing medical records until the set is complete
- Getting a deposition on the calendar of every party
- Chasing the warranty credit the distributor has not issued
- How do I find patients with treatment diagnosed but never scheduled?
- When does a dental plan year actually reset?
- How do I follow up on unscheduled treatment without sounding pushy?
- What is a treatment finder report used for?
- Why do accepted treatment plans never get booked?
Back to medical and dental practices, or see how this is priced and scoped.