Insurance Reimbursement Reconciliation

What this delivers

A clear picture of every claim — submitted, paid, outstanding

Each reconciliation cycle produces a structured account of where your insurance claims stand. Claims submitted are matched against payments received. Anything that doesn't line up — underpayments, denials, aging balances — is surfaced in a clear summary with the context needed to follow up effectively.

Over time, this gives you a detailed picture of how each payer relationship is actually performing. Collection rates by payer, denial patterns, average reimbursement timelines — the kind of information that helps you manage those relationships actively rather than simply accepting whatever comes back.

Claims matched

Every submitted claim matched against the payment actually received — no manual searching required.

Underpayments flagged

Payments that fall short of contracted rates are identified, not silently absorbed.

Denials tracked

Denied claims listed with aging status so nothing sits unaddressed beyond the appeal window.

Payer performance

Collection rates by payer tracked over time so you can see how each relationship is performing.

The challenge

Insurance payments don't always reflect what you're owed

Most dental practices submit claims consistently and collect a reasonable share of what's billed. But reasonable isn't the same as complete. Insurance reimbursement is a system with a lot of moving parts — contracted rates, timely filing windows, bundling rules, coordination-of-benefits scenarios — and each of those parts creates an opportunity for a payment to come back short, or not come back at all.

The problem isn't usually fraud or bad faith from payers. It's volume. A busy practice submits hundreds of claims each month. When payments arrive in batches across different payers on different schedules, manual matching becomes impractical. Underpayments arrive without labels. Denials sit in aging reports that no one has time to work through systematically. The result is a slow, quiet revenue leak — one that's rarely visible until someone does the reconciliation work.

For many practices, the true collection rate — what was actually collected versus what was contractually owed — is meaningfully lower than the stated collection rate. That gap is where reconciliation work has the most direct impact.

Where revenue typically slips

Underpayments that arrive below contracted rates without explanation or flagging

Denied claims that sit unworked past their appeal window

Aging balances for claims submitted but never resolved — no payment, no denial, no follow-up

Coordination-of-benefits errors where secondary payer responsibilities aren't pursued

Payer-specific denial patterns that recur because no one has tracked them across multiple cycles

Fee schedule discrepancies that have quietly shifted without formal contract updates

Our approach

Systematic reconciliation, every cycle

Thornveil's reconciliation service runs on a consistent schedule — bi-weekly or monthly, depending on your practice's claim volume and how closely you need to track reimbursements. Each cycle follows the same structured process.

01

Claims-to-payments matching

Every claim submitted during the reconciliation period is matched against the corresponding payment. Where payments have arrived, amounts are verified against contracted rates. Where they haven't, the claim enters the aging and follow-up summary. The matching is systematic — not a spot-check, but a complete pass through the cycle's activity.

02

Exception identification and categorization

Anything that doesn't match cleanly is categorized and summarized. Underpayments are identified with the discrepancy amount. Denials are listed with their stated reason. Aging items are flagged with their days outstanding and the action required to resolve them. The output is a clear list of items that need follow-up — organized so the right action is obvious for each one.

03

Payer relationship tracking

Over time, reconciliation cycles accumulate into a picture of how each payer is performing. Collection rates by payer, denial frequencies, average reimbursement timelines — these patterns become visible across multiple cycles in a way that no single reconciliation run can show. That longer view is often where the most useful insights about payer relationships emerge.

Working together

What each reconciliation cycle feels like

The goal is to make the reconciliation process something your practice benefits from without having to manage directly. Each cycle runs on schedule, and the output you receive is designed to be acted on — not interpreted.

Each summary tells you specifically what needs follow-up, with enough context that the appropriate action is clear — whether that's submitting an appeal, contacting a payer about an underpayment, or noting that a balance has crossed into write-off territory.

If your team handles insurance follow-up internally, the reconciliation summary gives them a clear, prioritized starting point each cycle. If follow-up is handled elsewhere, the summary serves as a complete record of outstanding items.

01

Data collection

Claims submitted and payments received during the cycle period are pulled from your practice management system. No manual data entry required from your team.

02

Matching and review

Claims are matched against payments, amounts verified against contracted rates, and any exceptions — underpayments, denials, aging items — are identified and categorized.

03

Summary delivery

A clear summary of the cycle arrives on schedule — claims resolved, outstanding items requiring follow-up, and payer-level performance notes where relevant.

04

Follow-up support

If your team has questions about a specific item in the summary, or needs clarification on how to approach a particular payer follow-up, direct communication is available.

Investment

Straightforward monthly pricing

Insurance Reimbursement Reconciliation

$300 / month

Bi-weekly or monthly cycle, based on your practice's claim volume
Complete claims-to-payments matching each cycle
Underpayments identified with discrepancy amounts
Denial tracking with reason codes and aging status
Aging balances flagged with days outstanding and required action
Payer-level collection rate tracking across cycles
Direct access for questions and follow-up clarification

The monthly fee covers the complete reconciliation process — data collection, matching, exception identification, and summary delivery. Cycle frequency (bi-weekly vs. monthly) is determined during setup based on your practice's claim volume.

What makes this different from in-house tracking

Most dental practices do some version of insurance follow-up internally. The challenge is that internal tracking often focuses on the obvious — large denials, clearly overdue accounts — while the quieter revenue leaks go unnoticed. A systematic reconciliation process covers everything in scope, not just the items that are large or visible enough to get flagged manually.

The other difference is pattern recognition. Internal follow-up tends to handle issues one at a time. Reconciliation across multiple cycles reveals patterns — payer-specific denial rates, recurring underpayment amounts, fee schedule discrepancies that have persisted for months — that only become visible when you look at the full picture.

Combining services

This service works well alongside Dental Practice Financial Management. The reconciliation data feeds naturally into monthly financial reporting — collection rates by payer become part of the broader financial picture, and the two services reinforce each other. Many practices find it useful to have both running together from the start.

Framework

How the reconciliation process works in practice

The reconciliation cycle is designed to be comprehensive — every claim in scope is reviewed, not just the ones that stand out. Here's what that process covers and why each part matters.

Matching logic

Why every claim is reviewed, not just exceptions

A selective review process — one that only looks at claims above a certain amount, or only at flagged denials — will miss underpayments that fall below the threshold and denials that never got flagged. The value of a complete matching pass is that it doesn't depend on an exception flag being set correctly. If it's in scope, it gets reviewed.

Cycle frequency

Why bi-weekly cycles matter for some practices

Higher-volume practices generate enough claim activity that a monthly cycle means some items sit for three to four weeks before they're reviewed. For practices with a large number of claims per month, bi-weekly reconciliation keeps aging balances from growing to a size where recovery becomes difficult — especially for items near appeal filing deadlines.

Progress visibility

What you can see after several cycles

After the first two or three reconciliation cycles, a clearer picture of your payer mix starts to emerge — which payers are resolving claims cleanly, which ones have recurring denial patterns, and where the largest gaps between submitted and collected amounts tend to appear. That picture informs how your team prioritizes follow-up and how you evaluate payer relationships over time.

Realistic expectations

What reconciliation surfaces — and what it doesn't resolve

Reconciliation identifies what needs follow-up and provides the context to act on it. The actual follow-up — contacting payers, submitting appeals, pursuing underpayment corrections — typically happens on your side or through your billing team. The reconciliation summary gives them a clear, organized starting point for each cycle's outstanding items.

2×

Cycle options

Bi-weekly for higher volume, monthly for steady-pace practices

100%

Claims reviewed

Every claim in scope matched — not spot-checked or filtered by amount

3+

Exception types tracked

Underpayments, denials, and aging balances each categorized separately

Our commitment

How we approach this engagement

Complete coverage

Every claim in scope is reviewed each cycle — not a sample, not the obvious exceptions, but a complete pass.

On-schedule delivery

Reconciliation summaries arrive consistently on your cycle schedule. No chasing, no follow-up needed to receive your reports.

Clear communication

Questions about items in the reconciliation summary go to someone who worked on it — with context, not generic responses.

No pressure, just a conversation

The first step is understanding your practice's current situation — claim volume, existing reconciliation process (if any), and what you're hoping to see more clearly. From there, we can outline exactly what the service would cover and how the cycle would run. If it makes sense for your practice, we'll both be able to see that in the conversation.

Next steps

Getting started

The setup process is straightforward. Most of the work happens on our side — you don't need to prepare anything unusual to begin.

1

Share a few details

Use the contact form to tell us about your practice — monthly claim volume, current reconciliation process, and what you're looking to address. No complicated intake form.

2

Initial conversation

We'll follow up to learn more about your payer mix, claim volume, and current process — and to discuss what the reconciliation cycle would look like for your practice specifically.

3

Setup and cycle start

We establish data access and configure the reconciliation process for your practice. The first cycle typically runs within the first two weeks after setup.

4

First summary delivery

Your first reconciliation summary arrives at the end of the initial cycle. We'll review it with you to make sure the format and detail level match what you need.

Frequently asked before starting

How do you access our claims data?

We work with data exported from your practice management system. The specific process depends on your software — we'll walk through the options during setup.

Do you submit appeals or contact payers directly?

The reconciliation service identifies what needs follow-up and provides the context to act on it. Actual payer contact and appeal submissions are typically handled by your billing team or biller — we provide the organized summary they need to do that work efficiently.

How do I know which cycle frequency is right for us?

We'll discuss your monthly claim volume during the initial conversation. Practices submitting a larger number of claims each month generally benefit from bi-weekly cycles — appeal windows close faster than monthly cycles can address at high volumes.

Can we switch cycle frequency later?

Yes. If claim volume changes significantly, or if you find the monthly cycle isn't keeping pace with your practice's needs, the frequency can be adjusted.

Get started

Ready to see exactly where your insurance collections stand?

Tell us about your practice and we'll follow up with a clear picture of what the reconciliation service would cover and how it would run for you.

Start the conversation

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