Dental Insurance Verification vs. Insurance Eligibility: Knowing the Difference  

The hoops you jump through to ensure your patients’ insurance information are in order are dizzying enough without further muddying the waters. One common point of confusion among dental practices is the varying jargon providers use to describe the insurance workflow and tools that help lighten that lift. 

You’ll likely hear several insurance management terms tossed around that, without being clearly defined, can cause head-scratching moments. For example, with dental insurance in particular, the patient eligibility process is often referred to as “eligibility and benefits verification,” “insurance eligibility verification,” or simply “insurance verification.” The problem is that much of this language can be ambiguous in describing the actual basic insurance steps that must be completed prior to appointments. 

In this article, we’ll define both insurance verification and insurance eligibility, look at how the two terms’ functions compare, and give you greater insights when seeking solutions to simplify your admin team’s insurance tasks. We’ll underscore how this knowledge can help you choose a technology that fits your dental office’s specific insurance needs. 

What are dental insurance verification and insurance eligibility? 

 Insurance Verification 

Insurance verification clearly spelled out is the process of several key insurance management tasks: 

• Viewing patient insurance details on file to ensure active status 

• Requesting the patient’s most current insurance basics and card photos 

• Verifying their insurance plan’s active status and coverage details 

The insurance verification process can involve multi-pronged, often-manual steps involving calls to payers or visits to payer portals, and/or checks to clearinghouse interchanges to collect the right insurance data. 

Insurance Eligibility 

The final step in your insurance process, insurance eligibility involves confirming how much remaining dental insurance benefit a patient has on their current healthcare plan prior to their appointment. This includes accessing details like code-level coinsurance, usage history, limitations, etc. 

How do insurance verification and insurance eligibility functions compare? 

The easiest way to differentiate the two types of insurance tasks is to think of it like this: 

Insurance verification covers the first 3 steps of the insurance process: 

• View, request/collect, and verify patient insurance 

Insurance eligibility completes the crucial 4th step: 

• Confirm remaining benefit usage details 

While manually completing verification and eligibility has become complex, time-consuming, and increasingly expensive, an automated dental insurance verification service can save you time, lower labor costs, and save office staff time. It can also help you reduce claim denials and resubmissions and help you create efficiencies in your front office. 

The average time it takes to complete each manual dental insurance verification is 13 minutes compared less than 1 minute with insurance automation. Similarly, each manual verification costs you $7.11 compared to only $1.48 using insurance software. Finally, an insurance verification and eligibility solution can save your dental practice an average of 40 hours per week on manual verification costs, including clearinghouse checks and staff labor. 

But if you already have a “dental insurance eligibility verification” tool or are considering one, it’s highly likely that it doesn’t perform all four steps of the insurance process. That’s because it likely doesn’t cover that critical fourth step of confirming a plan’s benefits usage. 

What are the benefits of an integrated insurance solution that both verifies insurance and confirms usage? 

You may not actually be reaping the full savings and speeding up your pre-appointment insurance management process if you don’t have technology that automates both verifying patient status and coverage and confirms their remaining eligibility and usage details. Even if you do have clearinghouse access to authenticate a patient’s usage, it likely doesn’t give you access to every dental insurance company that your practice accepts. 

A true, all-in-one insurance eligibility solution automates all four steps of the insurance process so that you can view, request, verify, and confirm patient insurance coverage and status in seconds. It performs both insurance verification and insurance eligibility functions, eliminating payer phone calls, using payer portals, and the need to check clearinghouses. 

A cost-effective way to streamline your entire insurance process, an insurance eligibility tool lets you: 

• Accelerate the collections process 

• Reduce claim denials and resubmissions 

• Optimize staff productivity 

• Spend less time on the phone 

• View up-to-date information at your fingertips 

• Improve patient satisfaction 

Key Takeaways

Manual and partially electronic insurance processes are complex, time-consuming, and increasingly costly. Similarly, most “insurance eligibility verification” tools simply help you complete the first 2 or 3 steps of the insurance workflow. Only a comprehensive patient insurance eligibility solution which enables you to view, request, verify, and confirm usage in seconds, can take you all the way. It helps you to boost collections, reduce claims, and save your staff up to 40 hrs. per week on insurance tasks, reducing your costs and accelerating your dental practice’s revenue.