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Running the Place, lesson 4 of 4
Choosing Dental Software When Many Patients Are on Medi-Cal
For a Medicaid heavy practice the software question is not charting or scheduling, because everything does those. It is eligibility checking, prior authorization tracking and how fast you find out a claim was denied.
- Test first. Eligibility checking on real patients
- Ask about. Prior authorization tracking as a real feature
- Watch for. Per claim fees that scale with your patient mix
- Non negotiable. Getting your data out if you leave
Eligibility Is the Whole Ball Game
Coverage changes month to month. A practice that checks eligibility on the day, automatically, for the whole schedule, writes off far less work than one that checks when somebody remembers.
In a demo, ask them to check a real patient in front of you and time it. Then ask what happens when the check comes back unclear, because that is the case that eats your front desk's morning.
Prior Authorization Is a Workflow, Not a Note
Plenty of treatment needs approval before you start. If your software treats that as a sticky note on the chart, somebody is tracking approvals in their head or in a spreadsheet.
Ask to see the list of outstanding authorizations, sorted by how long they have been waiting. If there is no such screen, you have your answer.
Find Out How You Learn About a Denial
The gap between a claim being denied and your team knowing is where money dies. Some systems surface it the same day. Some wait for somebody to open a report nobody opens.
Ask directly. When a claim is denied, what happens, who sees it, and where. Make them show you rather than describe it.
Read the Pricing the Way Your Practice Actually Runs
Per claim and per transaction pricing lands differently on a practice with a high volume of lower value claims. A price that looks fine for a cosmetic practice can be quietly expensive for yours.
Take your real claim count from last month and price it. Not their example practice. Yours.
Ask the Leaving Question Before You Join
Ask how you get your data out, in what format, how long it takes and what it costs. Ask it in the sales conversation, while they still want your business.
A vendor who answers that cleanly is telling you something about how they expect to keep you. A vendor who gets vague is also telling you something.
Run the Trial on Your Worst Week
Software demos beautifully on a quiet Tuesday. Run any trial through a full billing cycle and through your busiest days, with your actual staff rather than whoever is keenest.
Switching systems is expensive and disruptive, which means the cost of choosing wrong is much higher than the price difference between the options.
Before You Spend a Dime
Is cloud or server better for a small practice?
Cloud removes the server and the backups, which is usually the right trade for a small office. Check what happens to your day when the internet is down, because that is the real question.
Do we need a separate claims clearinghouse?
Some systems include one and some charge separately. Price it together, because the cheaper system with a separate clearinghouse is often not cheaper.
How long does switching take?
Longer than the vendor says. Plan for a slower schedule for a few weeks and tell your team that is expected.
Next Problem to Solve
- What a Dental Compliance Package Actually NeedsRelated. What is really in a dental compliance package, which parts a small practice can do itself, and where the paid bundles earn their money.
- Getting Paid by Denti-Cal Without Losing a MonthRelated. How to cut denials on Medi-Cal dental claims, which ones are worth appealing, and the front desk habits that decide both.
- Enrolling as a Medi-Cal Dental ProviderRelated. What enrolling in Medi-Cal dental involves, what slows applications down, and what to sort out before you start.