SMILE SECURE WORKFLOW: HOW WE PROCESS VERIFICATIONS

1. We Do NOT Wait for Tasks

We do not receive tasks from the office.

Every shift begins with:

1. Logging into the office’s PMS

2. Going to the schedule

3. Identifying all patients scheduled in the next 24 hours

This is our work queue.

2. Reviewing Patient Information in the PMS

We look at:

• Patient’s insurance on file

• Subscriber information

• Appointment reason

• Procedure codes (if attached)

• Notes from the office

• Last verification date in chart

This tells us what level of verification is needed.

3. Determine Verification Type Needed

For each patient, choose TWO of the following:

A. Full Dental Breakdown

Required when:

• New patient

• New year / new policy

• Insurance has changed

• Appointment includes major or basic procedures

• No recent breakdown in chart

• Office expects complete breakdowns for all visits
  

Includes:

• Portal verification

• Phone verification (when needed)

• Deductible

• Annual max

• Frequencies

• Limitations

• Code-specific coverage

• Treatment history

B. Portal Verification (Always)

Required when:

• New patient

• New year / new policy

• Patient is established

• Hygiene appointments

• Previously completed breakdowns exist

• Only updated benefits, active status, and frequencies needed

Includes:

• Active/inactive

• Max remaining

• Deductible

• Code-specific coverage for hygiene

• Network status

C. Active Status Only (When a BD is not needed)

Required when:

• Patient is established

• Hygiene appointments

• Previously completed breakdowns exist

We verify:

• Active/inactive
  
• Maximum and Deductible
• History for codes attached to the appointment

Why choosing the correct type matters:

• Avoids unnecessary work

• Ensures correct information is available

• Prevents the office from giving wrong estimates

• Ensures benefit details match the patient’s appointment

• Reduces denied claims