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suzanne
Canine III

Reconciling EFTs from Insurance Companies

Does anyone have an efficient method of tracking, matching, and reconciling their Insurance EFT payments?  Since most of our Insurance payments are through EFT now, this process is becoming a monster and taking way too much time to get payments posted. 

I need to ensure that what is posted in Softdent is what is deposited into our bank account, since we had a fiasco in 2016 when suddenly United Healthcare started sending our payments to a different bank account who was a private citizen unrelated to the office.  On Saturdays, I post all payments that were deposited into our bank account for the week.  However not all companies fax/email an EOB, so I have to check the bank account first and then go to each company's website to download a copy of the EOBs.  On top of that, some companies do not have EOB information on their website if we are not contracted or an out-of-state provider.  For those companies I actually have to call and have a representative email me the EOBs. 

And with the upsurge in network leasing and changing TPAs, some of the names on our bank statement aren't the actual company that made the payment.  So it becomes a cat and mouse game.  For example, our bank statement shows an EFT from BCBS Georgia.  I called BCBS Georgia which has no record of payment to us.  They said it could be from one of the companies that they administer, but not actually underwrite.  Without having the patient name (since we didn't have an EOB), this took another 3 departments, multiple transfers, and 2 more weeks of research to find who the payment was for!  This creates a problem when the deposit was in a previous month and I have to backdate the system to post the payment, then re-run all Final Daysheets and Month-End reports.

Also, the Delta Dental Individual Plans don't have the EOBs available on the National website.  I asked if we could get paper checks and EOBs for those patients.  They said since we are signed up with Delta Dental's National EFT program, we can't pick and choose which companies to get paper checks from.  So the solution is that I have to call to get the EOBs emailed to me.  And for those of you who have had to call an insurance company for anything other than simple benefits, you already know it's about a 30-minute process to get through the menu system, wait on hold, and finally get to someone who has the information you need!

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52 Replies
CS Dental Employee
CS Dental Employee

Re: Reconciling EFTs from Insurance Companies

Wow, this is amazing information - some of which I wasn't even aware of... I'd love to help, but because I'm not in an office everyday I'm not sure I have the correct best practices to share with you.  Tagging some others to see if anyone can lend us some advice.  

softdentgirl‌, pksaari79‌, mdunham‌, dr.cavola‌, barbhouser‌, doctom4300‌, bert‌, 

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pksaari79
Premolar III

Re: Reconciling EFTs from Insurance Companies

We don't take EFT's.....we ask for a paper check to which they have always given us. And lately, knock on wood, no one has told us we have to do this - for awhile Metlife told us we had to but when I called, I was told we did not have to do that. It is for this reason, your fiasco, that I do  not want to take EFT's.  And we are not contracted so our support would not be as good I do not think.  Sorry, I can't help you......Smiley Sad

drcavola
Premolar III

Re: Reconciling EFTs from Insurance Companies

Suzanne,

I certainly can appreciate the challenges you are experiencing with the myriad of EFT's and all those other acronyms.  However, not to criticize but rather to help .... your post "I need to ensure that what is posted in Softdent is what is deposited into our bank account" is ... in my humble opinion ... the old work flow way of thinking with paper checks and such.  The "new" work flow with EFT's is just the opposite.  The money is ALREADY in the bank.  You/your office and team have to find a way to get those payments in Softdent AFTER the fact (and attached to those insurance claim to reconcile the patient/account balance).  Here are a few tips that may help ...

a)  First thing in AM - I scan the newly posted EFT's in our account via online at our bank, then list them separately.

b)  I pass the list onto our FA (financial coordinator) to process that day (or, like today, those that came in last Friday too)

c)  Our FA then acquires the EOB's.  Today we had a few MetLife.  Those EOB's actually come via fax, and ahead of 

     EFT post date.  MetLife is easy for us.  On Wednesday we get a bulk Delta Dental.  That is relatively easy too, but

     sometimes a little challenging to post IF you post via "insurance payments" method and there are some DD claims

     to don't jive with the proper DD insurance company.  If you have that issue with posting in bulk, then call Support

     and they'd be happy to help you sort thru so that you can easily post (paper or EFT) multiple claims in one step.

d)  Occasionally our FA has to log into certain web sites (Ameritas, some DD's, Cigna, and others) to acquire the EOB.

e)  On "rare" occasions, I have to print the EFT post from our bank in order for someone to track at the Ins. Co end.

f)   At the end of the day, you should have EOB's that correspond with the appropriate EFT sum of payments for that

     day.  At this time, it requires a little extra work.  I should preface that by making sure that you and your office ARE

     posting with the appropriate EFT insurance code payment, ADA code 2.9.  There are some other code modifiers

     for some other EFT type payments, but if you are doing it that way, then your day sheet will calculate the sum only.

     It will not be in the check deposit portion.  If any of them do show up accidentally, then there is a posting error.

Hope that helps ... and hope this makes sense.  Most of our insurance payments now a days are EFT's.  It makes life

so much easier .... it is much more efficient in my opinion. 

CS Dental Employee
CS Dental Employee

Re: Reconciling EFTs from Insurance Companies

Thanks Dr Cavola, I am going to add a TIP

under the bank number I enter the carrier in Caps ie: METLIFE

Under the Check Number I enter the EFT Transaction #

in the notes I enter the DOS and a short note 

You can also print the Transactions for a period for code 2.90 with your desired date range. This reports will list all of the EFT payments you posted.

**** see below eft‌tyson.edwards

This was posted 1 year ago, I do not know when it will be available, but it will be a huge help when it comes to  balancing your EFT payments.

doctom4300
Premolar III

Re: Reconciling EFTs from Insurance Companies

When you say your FA processes the EFTs, how are they processed?

The only insurance company we've tried EFT payments with is MetLife. It was not good. We had to go to their website to get the EOBs, which would have been fine if the information on their site had been accurate. They started re-using trace numbers, so we would see EOBs for patients that had never been to our office. They completely left off EOBs, which we figured out when we ran an outstanding claims report. That report would show an outstanding claim, and when I checked the patient's information on the MetLife site, it showed it was paid via EFT at a much earlier date. I could only find the EOB by searching the patient. Searching the EFT deposits didn't show anything. Then I'd have to get the doctor to check if the corresponding EFT deposit actually came (I don't have access to the bank account). It was a mess, and we cancelled it.

"However, not to criticize but rather to help .... your post "I need to ensure that what is posted in Softdent is what is deposited into our bank account" is ... in my humble opinion ... the old work flow way of thinking with paper checks and such.  The "new" work flow with EFT's is just the opposite.  The money is ALREADY in the bank."

Yes, the money is there, but since MetLife can't accurately tell us what the money is for, we had to dig around. We needed to do it the old way to make sure we had everything posted. It was extremely time consuming.

If insurance companies are going to require EFT payments, they'd better get their act together.

drcavola
Premolar III

Re: Reconciling EFTs from Insurance Companies

As I mentioned, we get the faxes of EOB's from Metlife.  It's pretty straightforward from there.  Today, for instance, we got two MetLife EFT's posted to our bank account.  One for $388.50, and another for $1021.60.  Since the amounts are unique, it's pretty easy to determine who's is who's from the stack of EOB's ... there are identifiers associated with the EFT, but normally we don't need to delve that deep.  Yes, occasionally we'll see three of the same amounts ... if there are three in the ques then great.  I'd say about 95% of the time we don't have to play "inspector" with our EFT's.  It works for us ... I wish it was the same with everyone else.

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doctom4300
Premolar III

Re: Reconciling EFTs from Insurance Companies

Based on our experience with getting EFT payments from Metlife, switching to getting the EOBs via fax would not convince me that everything was accurate. I would still have to double check everything.

suzanne
Canine III

Re: Reconciling EFTs from Insurance Companies

Hi Kay,

I was trying to avoid mentioning the other fiasco we've had, which was employee embezzlement of $95,000 and the reason we were trying to go to all EFTs.  But perhaps that is relevant information as to why I am suffering through this EFT process and trying to make the best of it!

suzanne
Canine III

Re: Reconciling EFTs from Insurance Companies

Hi Ron,

Whether it's a criticism or a helpful hint, I'll take it!  This is a conversation that I hope benefits more than just me in the end.  And I realize that my situation is probably an extreme, which is why I'm reaching out.

Our problem with "the money is ALREADY in the bank" is that it was not in OUR bank account.  Our Collections Manager researched all outstanding claims by going to the websites and seeing if the claims were paid.  If they were "paid," she would just enter the payment in Softdent and close the claim.  Since she wasn't checking actual dates of payment/deposit or whose account the InsCo sent it to, the Daysheets wouldn't balance, so she entered them as EFTs thinking there wouldn't be a paper trail.  

So in following your steps, when you scan the bank account for EFTs "first thing in the morning," wouldn't they be the ones that were deposited the previous day?  If so, do you backdate Softdent and post those EFT EOBs for the day they posted to your bank account?

And regarding (e): I already know I will have at least one "regular" EFT that will require a call to the InsCo to track down the EOBs.  Since this process usually requires the Rep to get back to me at a later date, do you recommend I backdate Softdent to the date of deposit and then re-run final Daysheets?  If I post the EFT when the Rep gets back to me, I'm guaranteed a Daysheet that doesn't balance, and a monthly bank statement that doesn't reconcile.  So I'm still trying to get to your (f) where the Daysheet corresponds with the EFT payments for each day.

I appreciate your thoughts!