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Dental plan portals pave paths to patient benefit data

May 07, 2018

By Michelle Manchir

Editor's note: This is the 12th story in the Decoding Dental Benefits series featuring answers and solutions for dentists when it comes to the world of dental benefits and plans. The series is intended to help untangle many of the issues that can potentially befuddle dentists and their teams so that they can focus on patient care.

Photo of Dr. Watson
Dr. Watson
Surprises may be fun for parties, but most people don't want to be in the dark when it comes to the amount due on their health care bills.    

"No one likes surprises with money, so being able to help patients understand their benefit is beneficial to everyone," said Dr. Hope Watson, a Maryville, Tennessee, dentist and a member of the ADA Council on Dental Benefit Programs.

For Dr. Watson and her staff, patient portals "are the most time-effective, accurate way to attain and share information regarding dental plan benefits with our patients," she said.

Often, the portals give providers access to information necessary to manage patients benefit information, said Dr. Daniel Croley, vice president of network development for Delta Dental.

Depending on the functionality of the portal, dentists can potentially find a cornucopia of information, such as member eligibility and benefits, claim submission, claim status and history. Sometimes other information is available to help the dentist better work with the dental plan, including provider manuals and print-on-demand forms.

For example, Dr. Croley said, the provider portal at Delta Dental of California, which also includes its affiliates Delta Dental Insurance Company and Delta Dental of Pennsylvania and New York, not only provides eligibility and benefit information, but also allows offices  to submit real-time claims and pre-treatment estimates and check claim status and see claim history, if that history is in the claim system.

"We recently enhanced our provider portal by allowing dentists to see a summary of patient eligibility for all covered Delta Dental patients, regardless of which Delta Dental Member Company has the business," Dr. Croley said. "This similar functionality is available on other Delta Dental Member Company portals as well."

For providers of patients with Aetna dental plans, providers can connect to a real-time eligibility vendor's website via Aetnadental.com at no cost if they are a contracted provider to access members' plan information, an Aetna spokesperson told the ADA News. Information such as eligibility dates, plan benefits, plan limitations, deductibles and frequencies is available there.

DDB LogoMany other providers, including Ameritas, United Concordia and Humana, also have portals that contain at least basic information about patient benefits.

Dr. Watson said her office uses provider portals on a daily basis, often to verify patient eligibility and check claim status.

"Our office finds that by utilizing this information and educating the patient with it, our collections have increased because we can inform the patient of exactly what their financial responsibility is," she said.

Using the portals saves her office time, she said, with "no wait time on phones, only to be transferred to the next available operator."

Though typically a patient's plan is straightforward and easily understood from portal information, there will be occasions where speaking to a person may still be needed, said Dr. Croley.

"We know that sometimes benefit plan information is complicated," he said, adding that use of the provider portal reduces call volume for Delta Dental's customer service representatives.

"The information delivered on our provider portal is from the same core operating system that a customer service representative would access to answer questions on a call," he said.

Dr. Watson said that, in her experiences, occasionally some dental plans use third party websites as their portals, which may pose problems such as not being able to get pre-estimates or see the status of claims pending.

"Often times we aren't able to get the immediate information the patient needs," she said.
Still, Dr. Watson said she views patient portals overall as "very effective."

"If offices are not using this as a service to themselves and for their patients, I strongly suggest they educate themselves and put it into practice," she said.    

Staff from the ADA Center for Dental Benefits, Coding and Quality can help dentists with dental benefits-related and coding problems, questions and concerns. Call 1-800-621-8099 or email dentalbenefits@ada.org.

The ADA has created a landing page for dental benefits information that can help dentists address and resolve even their most vexing questions, ADA.org/dentalbenefits, part of the Center for Professional Success.

Previous installments in the Decoding Dental Benefits series are available at ADA.org/decoding.