Insurance & TPA Claims
Dentospire's insurance module lets a dental clinic record each patient's policy, raise a claim from the invoice, and track it through approval, rejection, appeal and payment, including what the insurer settled short.
The problem in a real clinic
Claim numbers live in a diary, and nobody notices that a TPA paid less than claimed until the quarter is over. By then the patient has gone, the paperwork is gone, and the difference is simply written off.
How it works
- Add the insurers and TPAs you work with — TPA, government scheme, private or corporate — with contact and empanelment details.
- On the Patient Policies tab, record a patient's policy once: insurer, policy and member number, plan, coverage and annual maximum.
- Raise a claim from the patient's invoice; it gets its own number and date for the reference you give the insurer.
- Move the claim along as the insurer responds: submitted, under review, approved or rejected with the reason, appealed, paid.
- When it settles, enter the approved amount. A lower figure marks the claim partly approved and puts the difference on the patient's share.
What you see on screen
- Pending Recovery: money insurers have approved but not yet paid, the figure worth chasing.
- Each claim's status, its approved amount and any shortfall, on the claim itself.
- How much of a policy's annual maximum has been used, worked out from its claims.
Safety and control
- Claims, policies and settlement figures are limited to staff with the Finance permission, checked on the server.
- Every claim is tied to an invoice, a patient and a policy of your own clinic; one clinic cannot raise a claim against another's records.
- A settlement entered wrongly can be corrected, and the policy's used amount recalculates from the claims instead of being edited by hand.
- A rejection keeps the insurer's reason, and an appealed claim stays in your pending work.
Good to know
- Insurance and claims need the Pro plan or above.
- Dentospire tracks claims; it does not send them to insurers or TPAs. Submit claims through the insurer's own portal or paperwork as you do today.
- Government schemes can be recorded as a provider, but there is no scheme-specific claim workflow.
Frequently asked questions
Does Dentospire submit dental insurance claims to the TPA?
No. Dentospire is a claim ledger: you raise and submit claims through the insurer's own process, and record each step in Dentospire — submitted, under review, approved, rejected, appealed or paid — so nothing is lost between them.
How does Dentospire handle an insurer that settles less than claimed?
Enter the approved amount when the claim settles. If it is lower than the claim, the claim is marked partly approved and the difference is placed on the patient's share, so the gap is visible straight away instead of at month end.
Which Dentospire plan includes insurance claim tracking?
Insurance and claims are part of the Pro plan and above. On other plans the Insurance pages explain that an upgrade is needed instead of letting you record claims.
Can I see how much insurers still owe my dental clinic?
Yes. Pending Recovery shows claims that insurers have approved but not yet paid. It leaves out claims settled long ago, so the figure is the money worth following up now.
Related
GST Billing
GST invoices with the CGST/SGST or IGST split worked out, part payments, and print, PDF or WhatsApp share.
Ortho & Long-Treatment Payment Plans
Split a long case into monthly amounts that advance on their own, so a paying patient never lands on your overdue list.
Specialist practices
Long treatment arcs, staged payments and imaging that has to stay attached to the case for years.