Historically, most insurance companies issue claim payments by mailing providers a check and an associated hard copy of the Explanation of Benefits (EOB). In recent years, these companies have transitioned away from mail to an electronic payment/direct deposit system with an electronic EOB. Many insurance companies were incentivizing providers to switch to electronic payment processing by offering a higher percentage of compensation (1-2% more). Electronic payment processing gave the providers a faster payment option and, in some cases, increased reimbursement for the completed procedure. For insurance companies, the benefit of electronic processing was reduced overhead expenses. 

But what has changed? Now, some insurance companies are contracting with third-party administrators (TPA) to handle their electronic claims processing, and the claims administration processing fees are now shifting to providers. These TPAs are utilizing two payment options that have hidden processing fees:

• Fax/email a virtual electronic credit card 
• Direct deposit/electronic payment into the practice's checking account 

The new processing methods are often imposed without the dental office's approval. Practices may start receiving virtual credit cards via fax or email. If the office accepts the virtual credit card payment, they may have to pay a 2-3% credit card processing fee on each card, depending on the terms of the practice's credit card processor. Likewise, if direct deposit/electronic payment is accepted, the bank may charge providers a 1.9% fee on each deposit into the bank account. With either option, the dental practice is receiving less compensation than if reimbursed with a paper check.

Be Aware!
Some of these companies allow you to opt out of methods that don’t work for your office, but those opt outs may only be good for one year, so you may have to opt out annually. 

Each practice must decide what claims payment process works for their office. Talk with staff to review how the practice handles virtual credit card transactions. The Massachusetts Dental Society (MDS) Dental Practice and Benefits Committee recommends directly contacting the insurance companies your practice works with to discuss the available claims payment processing options. Once you know your options, you can decide what process works best for your practice.

Published June 2024.