Rayan FaroukThe world of dental insurance claims is quite intricate in the United Arab Emirates (UAE). As essential as oral health is, navigating the complexities of insurance claims can be a scary task. But don’t be afraid, as we go through this friendly and informative journey, we will help you streamline the process and ensure a smooth experience for both you and your patients.
The UAE dental insurance landscape is diverse, with various providers offering different coverage plans. Familiarizing yourself with the policies and procedures of these providers is crucial. Take the time to study the terms and conditions, as they often vary between insurers.
If this is your first lesson, let’s take it step by step. First, learn about the people involved:
- Policyholder/Insured: That’s the patient, the person with dental insurance coverage.
- Healthcare Provider: That’s you, the clinic or doctor that treats the patient.
- Insurance Company: The company that provides dental insurance and handles claims.
Dental Insurance companies usually have a list of treatments and services that they cover and don’t cover. Each insurance company creates a deal with the dental clinic to set individual plans specific to the clinic. Those dental insurance plans will tell you how much the insurance company will pay for the treatments, patient co-pays and coverage. A co-pay is a set percentage you pay when you get a service, for instance, if your co-pay is 20% of the dental treatment that costs AED 100, you pay AED 20 and the insurance pays the rest.
Health insurance claims in the UAE are divided into two types: Direct Billing and Reimbursement. Direct Billing Claims mean that the insurance provider will directly pay you – the clinic -, for the services you do to the patient. Reimbursement means the patient is the one paying for the treatment at first. Then the patient sends the bill to the insurance provider, then they give them the money for things they cover.
Step 1: Verify Patient Insurance Information
The first step in the claims process is to verify your patient’s insurance information. Ensure that all details, such as the card ID and the coverage period are accurate and up-to-date. This step helps avoid potential claim rejections due to incorrect information.
Step 2: Determine Coverage Eligibility
Before providing any dental services, confirm your patient’s coverage eligibility. Some insurance plans have waiting periods for certain procedures or may not cover specific treatments. This knowledge ensures transparency with your patients about potential out-of-pocket expenses.
Step 3: Use Appropriate Dental Codes
Assigning the correct dental codes to each procedure is crucial for a smooth claims process. The UAE follows the International Classification of Diseases (ICD) and Current Dental Terminology (CDT) coding systems. Familiarize yourself with these codes and update them regularly to reflect any changes in the industry.
Step 4: Submitting Claims Electronically
The first step is the Prior Authorizations, it allows dental clinics to determine a patient’s coverage. While sending the pre-authorization request, dental billers must include detailed documentation like perio-charts, X-rays, treatment plans and other supporting documents.
The next step is sending the claim. Utilizing the online portals provided by insurance companies to submit your claims promptly. Electronic submissions not only expedite the processing time but also minimize the risk of errors associated with manual submissions.
Step 5: Follow Up on Claims
Once the claim is submitted, the waiting game begins. Periodically follow up with the insurance company to ensure that your claim is being processed. Be prepared to provide any additional documentation or information requested promptly. Timely communication can help resolve issues and prevent unnecessary delays.
Step 6: Understanding Rejected Claims
A claim submission with errors will most likely be rejected or will take an extended period before processing. Clean claim submission is characterized by properly coded procedures, accurate patient demographics, attached relevant treatment documents and timely submissions. But don’t panic, it could be a simple administrative error or a misunderstanding of the treatment necessity. Clarify any mistakes with the insurance company and resubmit the claim promptly.
In the UAE, all claims are sent through eClaimLink. eClaimLink is the eClaim project of the DHA implemented to establish a unified standard of healthcare. It’s an online platform that enables healthcare providers to electronically submit claims on behalf of their patients. You can check our blog titled “Revolutionizing Healthcare with eClaimLink” on our website to learn more about eClaimLink and know how to use it.
As for actually submitting the claims, don’t bother with DHPO and the long haul. Find an EMR system that is integrated with eClaimLink to streamline the data exchange and workflow within a healthcare organization.
Balsam Medico is a Cloud-based, Modern, Clinic Management System that allows you to provide better patient services. From within Medico, you can check the eClaimLink Configuration and submit all your claims with a few clicks. You can contact us at the numbers mentioned below for more information on the integration.
Navigating dental insurance claims in the UAE may seem like a labyrinth, but with knowledge and a systematic approach, dentists can streamline the process for themselves and their patients. By following this step-by-step guide, you can enhance the efficiency of your practice, minimize claim rejections, and provide a seamless experience for those seeking your dental expertise. Let’s get to navigating.
Connect with Us
Ready to embark on this exciting journey? Contact us today: 📍 Dubai, United Arab Emirates – Tel: +971 56 123 6043 📍 Khartoum, Sudan – Tel: +249 91 273 1048
Explore Balsam Medico and discover a world of efficient clinic management at www.balsammedico.com. Together, let’s reduce fines, elevate efficiency, and embrace a new era of dental healthcare.
Join the Balsam Medico newsletter for exclusive content and the latest news. Be the first to view valuable information and updates!
