S2 Episode 5: Green Flags & PPOs: Delivering Excellence in Eligibility

In this episode of Inside Dentistry Support, CEO Sarah Beth Herman discusses the crucial role of the eligibility department in ensuring the smooth operation of dental offices. She emphasizes the importance of performing eligibility tasks accurately and efficiently, highlighting the difference between 'red flag' and 'green flag' behaviors. Red flags, such as poor communication and incomplete verifications, cause stress and rework, whereas green flags, like detailed breakdowns and proactive follow-ups, set the standard for professionalism and reliability. Herman urges the team to adopt green flag behaviors to enhance overall team performance and client satisfaction.

Transcript

   📍 Hey guys. Welcome back to Inside Dentistry Support. I'm your CEO Sarah Beth Herman, and today I wanna zoom in on one of the most important parts of our team, you, our eligibility department. We're talking about what it means to give and receive tasks like a Green Flag team member, specifically when it comes to verifying dental insurance and working directly with our clients.

You are on our eligibility team and this episode is for you. Now, you might not always see it, but you are the very first line of defense for dental offices' success with their specific day when eligibility is done right, when it's clear, when it's clean, when it's on time, when it's done in advance, it actually saves our front office team members from the stress.

It saves our providers from confusion and it saves our patients from unexpected bills. But here's the kicker. Eligibility support for our dental offices isn't just about checking a box, and I know that it feels like that, but really it's about how you check the box, how you receive the tasks that are asked of you, and how you deliver what you find.

So I wanna talk about red and green flags today. And here at Dentistry Support, our culture is all about being a Green Flag team member. So I'm gonna start with what a red flag team member looks like. And I want you to take notes on this. I want you to look inside and say, Hey, am I displaying a red flag or am I displaying a green flag?

So let's keep it real. These red flags are not the culture around here. Saying done with no breakdown or details. So if you're someone who's saying, done, completed, but you don't give any more information and you're just giving one word replies, you are actually a red flag team member. If you are uploading a blurry, poorly cropped screenshot with zero explanation, you are a red flag team member.

If you are assuming what to verify instead of checking the list, checking with the office, asking for clarity, making sure you check in to see what they need. You're a red flag team member. If you are failing to clarify ortho frequencies, limitations missing tooth clauses, you are a red flag team member if you are ghosting the team when you're behind or confused.

That's a big one. You have to respond. You can't just not be present. Red flag team members, they cause us to have to rework things. They cause us to stress out. They cause the office to freak out on us and they weaken the standard that we promise our dental practices. And that's not what we're about here at Dentistry support.

So let's talk about green flag behaviors that we expect and that we celebrate. This is the good stuff. This is the bar that we are all measured at. Green flag eligibility. Team members confirm receipt of a task and include the day and time they'll complete it if someone needs an eligibility verification.

Yes, I will have that done in 30 minutes and I'll come back here, comment and tag you and show you what I found. They return full, easy to read, breakdown of benefits, not just screenshots, but a documented summary with the plan type frequencies, detectable and key exclusions. They message if something is unclear or if the insurance was closed, inactive, or pending, or unable to be reached for whatever reason.

They let us know when they're going to follow up, not just insurance is closed. Can't do it. Sorry. Unable to contact them. Couldn't get through. Nope. We actually give a full explanation so that everybody is aware because we aren't mind readers around here and our green flag team members, they always circle back when they're complete so that there's no mystery.

It's not over communication, it's professional communication, and our clients, they notice the difference. Let's do a side-by-side comparison. Red flag delivery would look like this. Verified United Concordia attached a screenshot. A green flag delivery would say completed verification for Maria Gonzalez, July 11th appointment plan, United Concordia PPO $50 deductible.

1500 max two cleanings per year. Six month spacing. No waiting periods. Ortho covered at 50%.  $2,000 lifetime max, no age limit. Screenshot attached for backup. Now that is a green flag. It's clean, it's complete. That is dentistry support. This is just as important. When you receive a task, you need to be a green flag receiver.

Don't ignore it. Don't say on it and disappear. Don't assume, ask if you're not sure what to verify. Do confirm when you'll get it done and follow through. Green flag team members help their team breathe easier because they remove the guesswork. What we do in eligibility is more than data entry. It is first contact excellence.

This is a client's first real experience with our accuracy. This is their first experience with our professionalism and our communication style. Be the standard. Be the one who shows up prepared, thorough and clear because that is who we are. You are not just verifying benefits. You are setting the whole day up for success.

You are protecting the patient, the provider, and the team behind the scenes. So here's the reminder. If it doesn't feel like a green flag, pause and reset before you send it, because your work matters when a client doesn't need to double check your work. That is good when you send back a full, beautiful breakdown with questions already answered.

That's good. And when the team looks at eligibility and smiles instead of size, that is dentistry support. Good.  📍 I'll see you guys on the next episode.