Dental insurance verification that catches denials before the visit
FirstOps checks dental insurance before the visit: eligibility, frequency limits, other insurance and plan restrictions, so fewer claims come back denied.
Most dental denials are decided before the patient sits down. The plan had already paid for that procedure this year. Another insurer should have been billed first. Coverage lapsed last month. The procedure is not covered on the member's plan. None of these can be fixed by a better claim; they can only be caught before the visit.
When we read a practice's remittances line by line, eligibility and benefit-limit denials are consistently among the largest groups of denied dollars, and nearly all of them are preventable with a check before the appointment.
What we check before each visit#
- Eligibility: is the patient covered on the date of service, under the plan you have on file?
- Frequency limits and history: has the plan already paid for this procedure within its limit? For example, one payer we work with allows a core buildup (D2950) once per tooth every 60 months, and a limited number of periapical X-rays per year. When the remittance names the earlier claim that used the benefit, it is often the practice's own.
- Other insurance: does another plan pay first? Billing the secondary insurer first is a common, avoidable denial.
- Plan restrictions and coverage: is the procedure covered for this member's plan at all, and does it need prior authorization?
- Patient portion: what the patient will owe, so the conversation happens at the front desk instead of on a statement.
How it fits your day#
Verifications run ahead of the schedule, and the results land where your front desk already looks, in your practice management system. Patients with a problem (lapsed coverage, a benefit already used, another insurer to bill first) are flagged before the appointment, with what to do.
Works in your practice management system#
FirstOps works with any practice management system. Most practices we work with today run Dentrix Ascend, Open Dental or Curve Dental.
Why verification and posting belong together#
Posting tells you why claims were denied; verification stops the same denial from happening again. Because FirstOps does both, the patterns we see on remittances (which codes hit frequency limits, which payers need another insurer billed first) feed straight back into what we check before the next visit. See insurance payment posting.
Frequently asked questions
What is dental insurance verification?
Confirming, before the appointment, that a patient's dental plan is active and what it will pay for the planned procedures: eligibility, frequency limits, other insurance, waiting periods, plan restrictions and the patient's share.
What is a frequency limit?
The number of times a plan will pay for a procedure in a period, for example two cleanings a year, or one core buildup per tooth every five years. Treatment done after the limit is used is denied, even if it was clinically needed.
Why do claims get denied for "other insurance"?
When a patient has more than one plan, the primary plan must be billed first. If the secondary plan is billed first, it denies the claim and asks for the primary insurer's explanation of benefits.
Do you verify Medicaid dental plans?
Yes. Medicaid dental programs and commercial plans are both supported.
How much does it cost?
Verification is quoted separately from payment posting, based on your visit volume and payer mix. Book a demo and we will price it from your own numbers.