In the digital age of healthcare, dental payers who have not adopted electronic, paperless, and digital processes are at a disadvantage.
Outdated technology and manual operations can negatively affect payers' ability to compete in the commercial dental marketplace.
By transforming time- and labor-intensive processes with technology that enables paperless workflows and electronic relationships, payers can reduce errors and manual re-work, increase profitability, improve member and provider satisfaction, and position themselves to scale quickly as their business grows.
Alleviating the burden of credentialing
Paper-based credentialing processes are a barrier to dental benefit plan profitability and convenience in provider network management. Credentialing is a significant administrative burden for both payers and providers, and outdated processes complicate network management. On-demand credentialing can solve these challenges and create a competitive advantage, attracting high-quality providers to a network.
Here's how it works: Providers are guided step-by-step in uploading their credentialing information to a web portal. It's one-and-done. They never have to upload again, just update their information as needed. Commercial dental payers who subscribe to the online credentialing service can access and download accurate, complete provider records on-demand. Within minutes they have the data they need, eliminating multiple outreach attempts and the weeks of waiting, typical with mailed applications.
On-demand credentialing through an experienced technology partner:
- Removes the burden of credentialing and provider data management for payers
- Eliminates the administrative work and duplicated effort for providers
- Makes complete, accurate provider data available in real-time
- Ensures ongoing compliance with federal and state regulations
Reducing time and effort with eligibility verification
Eligibility verification is another time- and labor-intensive process that can be transformed with an on-demand solution. Verifying dental plan member eligibility through a web portal takes only three to four minutes, rather than the 30 to 45 minutes provider staff members spend on the phone with this task. With digital technology, providers can quickly check a patient’s eligibility for specific services performed by the provider at a specific clinic location on the date of service. They can also do a fast eligibility check of matching dental plan members and dependents, and verify multiple members’ eligibility simultaneously.
With some systems, providers can also generate reports to view details about a patient's eligibility and general benefit plan information. By choosing an on-demand solution for eligibility verification, payers can improve providers’ satisfaction while reducing their own time and cost in responding to provider inquiries.
increasing efficiency, speed, and satisfaction in provider relationships
While payers can't entirely eliminate administrative burden, they can significantly reduce the time and human resources required for dental benefit administration by implementing digital solutions that drive electronic relationships with providers. Digital solutions reduce the costs for handling calls and paper transactions for both payers and providers, while enabling the increases in efficiency and speed that elevate healthcare in the digital age.
As an example, portal solutions exist today that digitally connect healthcare payers and providers, and help payers efficiently build, maintain, and expand networks of high-performing providers. In addition to credentialing and eligibility verification, these digital solutions enable providers to submit authorizations online and receive determinations the same or next day. Electronic claims submitted by providers can be paid by electronic funds transfer (EFT) within a few days, and providers can elect to receive daily payments.
The ability to submit authorizations and claims, receive and view statements, receive daily payments by EFT, and use digital tools like an instant online claim estimator, creates efficiencies for dental practices, so providers can focus on delivering excellence in dental care.
The Win-Win for Payers and Providers
Digital and on-demand solutions that create paperless workflows and electronic relationships benefit both dental payers and providers. Payers can attract high-quality providers and improve provider satisfaction with streamlined, online business interactions. And, by eliminating manual processes and reducing errors and re-work, these solutions help payers drive increased plan profitability and stronger provider engagement, ultimately helping them gain the competitive edge.