Insurance

Dental insurance management software

Each insurance company with its own price list, its own co-pay and its own approval rules, applied automatically when the invoice is built. Eligibility checks and claims run from the same record rather than from a portal somebody has to log into.

Request a demo All features

MedGulf4 plans · Approval requiredActive

Bupa Arabia3 plans · Direct billingActive

Tawuniya2 plans · Pre-approvalActive

Al Rajhi Takaful2 plans · ReimbursementReview

Policies & plans

MedGulf · GoldPOL-81385020% co-pay$50k limitValid

MedGulf · SilverPOL-77120430% co-pay$25k limitValid

Bupa · ExecutivePOL-66091110% co-pay$80k limitValid

A price list per company, applied automatically

Insurers do not pay the same rates, and working the difference out at the desk is where money is lost. Set the price list, the discount and the co-pay per company once, and every invoice for a covered patient uses it.

Custom price list per insurance company and per plan
Co-pay percentage and annual coverage limit per policy
Automatic split into insurance share and patient share
Exclusions and pre-approval requirements per procedure
Policy number and expiry held on the patient file

Insurance company settings in Dentolize, with a price list and coverage rules held per company

Eligibility and approvals without a portal

A check runs when the appointment is booked, so coverage, remaining limit and co-pay are known before the patient sits down. Treatment plans that need pre-approval are submitted and the insurer’s decision comes back into the record.

Eligibility check at the time of booking
Pre-approval submitted from the treatment plan
Decisions recorded against the patient and the plan
NPHIES integration for Saudi Arabia, with automatic approvals

The insurance policies screen in Dentolize on desktop, showing policy type, limits, discount and approval requirements

Claims tracked until they are paid

A claim is not finished when it is sent. Dentolize keeps the state — sent, approved, partially approved, rejected, paid — so you can see what is outstanding with each insurer and chase the ones that have stalled.

Claim status per patient and per company
Rejections with the reason, so they can be resubmitted
Outstanding balances by insurer, not just by patient
Reports on approval rate and average settlement time

A patient’s insurance details attached to their file, so the covered share is applied to the invoice automatically

Who works with insurance

Insurance is where clinics quietly lose margin, usually because the person at the desk cannot see the rules at the moment they matter.

Reception

Coverage, remaining limit and co-pay on screen before the patient is seated.

Dentists

Whether a planned procedure needs pre-approval, and whether it has been granted.

Owners

What each insurer owes, how long they take, and which ones reject the most.

Spreadsheets versus insurance management

Every clinic that bills insurance has a spreadsheet of rates. It is always out of date.

Doing it by hand

Rates in a spreadsheet nobody updates
Coverage checked by phone
Pre-approval chased by email
Claims tracked in a notebook
Rejections found at month-end

With Dentolize

A price list per company, applied on the invoice
Eligibility checked when the appointment is booked
Approvals submitted and returned into the record
Claim status held against the patient
Rejections visible with their reason

Questions

Insurance — frequently asked

Can each insurance company have its own prices?

Yes. Every company, and every plan within it, can carry its own price list, discount and co-pay, and the right one is applied automatically when the invoice is built for a covered patient.

Does Dentolize support NPHIES?

Yes. For Saudi Arabia, eligibility checks and pre-approvals run through NPHIES, and approvals can come back automatically without anyone re-keying them into a portal.

How are claims tracked?

Each claim carries its state — sent, approved, partially approved, rejected or paid — against the patient and the company, with the rejection reason recorded so it can be resubmitted.

Can I see what each insurer owes me?

Yes. Outstanding balances break down by insurance company as well as by patient, with ageing, approval rate and average settlement time in the reports.

What happens when a policy hits its limit?

The remaining limit is held on the policy and checked when treatment is planned, so the split moves to the patient rather than producing a claim that will be rejected.

Keep going

See Insurance on your own clinic

Thirty minutes on how your clinic actually runs, not a generic slideshow. We will call you within 24 hours.

Request a demo WhatsApp us