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The True Cost of Insurance Denials; Automated Verification Can Help

By Robert McDermott

March 31, 2023

In 2021, nearly 70 percent of providers noted insurance denials were increasing. The same research revealed 27 percent of those are related to registration and eligibility. With those numbers, it’s no wonder more practices are looking for solutions to automate the process and increase their accuracy. Automated Insurance Verification (AIV) has significant benefits and one of them is decreasing insurance denials.

Top Causes of Denials

There are countless reasons for insurance denials. It would be difficult to provide an exhaustive list as sometimes claims depend upon the insurer. However, there are a few top reasons you, as dental providers, can prevent.

  • Necessity – In this case, insurers do not believe the treatment or procedure are necessary.
  • No coverage – The treatment actually isn’t covered by the patient’s insurance.
  • Out of Network Provider – Some insurance companies require covered procedures be performed by providers who are in their network.
  • Cost – Typically, if a treatment is denied for cost, the insurer believes there is a less expensive available option to achieve the same results.
  • Procedural Failure – For some treatments, insurers require prior authorization, and failing to get this may result in a claim denial.
  • Missing or Incomplete Information – Requests for procedures often require details about the need or the problem itself. Failure to include this information may result in a denial and require a call back.
  • Administrative Errors – Administrative errors range from incorrect names, birthdates or even incorrect coding for the procedure.

The True Cost of Denials

Often, patients do not fully understand their benefits or stipulations to care (such as in- and out-of-network providers), which can create problems, particularly when a treatment or procedure has been either recommended or already performed. So, when the insurance denial occurs, there can be a bit of sticker shock when the true out-of-pocket cost is discussed. This, undoubtedly, has an impact on patient trust as well as the patient/provider relationship and could impact future care and patient retention.

In addition to the very real impact denials have on your patients (and their health), there’s also a significant impact to your practice. Any time you have to resubmit a claim, you not only incur additional costs (anywhere from $25-$118 per claim), but you also delay your cash flow.

The research also indicated nearly 65 percent of denied claims are never resubmitted which means money is being left on the table. On top of all of this, you’re likely contending with staffing shortages and the verification process requires considerable human resource utilization.

How AIV Works

Highly productive AIV solutions have the potential to look at your full schedule of patients and verify their coverage as well as any changes in their plans and available benefits. This modern, cloud-based software often completes reports in seconds, whether you have a hundred patients on your schedule or a thousand. This frees up your team to focus on additional tasks and customer service.

Further, with up-to-date insurer connections, you can verify current coverage; you also can identify coverage for future treatments and book those before your patients even leave your office. In short, AIV enables you to ensure coverage and cash flow.

How AIV Reduces Denials

Not only does AIV improve your team’s efficiency and your revenue generation, but it can also help you reduce insurance denials.

More specifically, when you are carefully vetting modern verification software, look for products that include automatic error identification, addressing administrative problems or incomplete information before it becomes a problem. As a result, your error-free claim submissions can mean higher case acceptance and far less time spent on appeals and callbacks or corrections.

Additionally, because your entire patient schedule is verified before they enter the office, with up-to-date benefits information, you can be sure a treatment is covered so there’s no claim denial later. Your team can be prepared well ahead of the patient appointment and share up-to-date claim information with the patient in the office.

In short, AIV can help stop many of the reasons for insurance denials before they happen, ensuring your patients get care, you get paid and your  patient/provider relationships flourish.

Robert McDermott is President & CEO of iCoreConnect. iCoreConnect’s iCoreVerify AIV software is like gaining an extra team member without the overhead. iCoreVerify completes AIVs (up to seven days in advance) for every patient on the schedule. Book a demo at to see how it can reduce your costs and provide efficiency or call 888-810-7706. MDA members receive a discount on iCoreVerify by iCoreConnect. iCoreConnect is an MDA Solutions Center Allied Business Participant. Click to visit their Solution Center listing.