Remote dental billing processes involve a range of things, keep an eye on KPIs, and need precision. This is a list of day-to-day operation:

A. Insurance Verification & Pre-Authorization

• Perform real-time eligibility verifications with providers like Vyne Dental or DentalXChange.
• Authenticate patient benefits, deductibles, waiting durations, and exclusions before treatment.
• Record results to prevent claim denials and patient resistance to billing.

B. Claim Submission & Error Scrubs

• Enter or confirm CDT, CPT, and ICD-10 codes into PMS platforms (Dentrix, Eaglesoft, Curve Dental, Open Dental).
• Use AI-driven claim scrubbers (e.g., Pearl AI, Overjet) to flag missing data.
• Submit clean claims and follow their status via clearinghouses.

C. Payment Posting & Reconciliation

• Process ERA and EOB reports to post payments from patients and insurers.
• Make posting adjustments, track copays, write-offs, and rejections.
• Reconcile accounts to identify errors before they add up.

D. Denial Management & Appeals

• Read denial reasons and track patterns.
• Construct appeal packets with docs, clinical notes, and photos.
• Use integrated tools for tracking pending appeals and resubmissions.

E. Patient Billing & Follow-Up

• Send automatic statements and reminders.
• Respond to patient billing inquiries about coverage and cost estimates.
• Work with clinics to set up payment plans, and age older unpaid accounts first.

F. KPIs & Reporting

• Track metrics: net collection ratio, first-pass acceptance rate, denial rate, AR >30/60/90 days aging.
• Pull dashboards or Excel reports for office managers or DSOs.
• Tune processes to remain on track with key targets.