The Truth About Dental Claims
One of the easiest mistakes to make in the dental claims world is to assume. There are nuances to even the most straightforward systems and the claims process is no different. Let us bust some myths for you so that you know what to watch out for.
Myth #1: All dental submissions make it to the insurance company.
Truth: Not quite! As will be explained, there are a number of reasons dental claims don’t make it to that final destination. In fact, it’s been said that 1/3 of the claims sent never get to the insurance company the first time! Insurance verification, data entry, and Payer IDs all pay major roles in making sure your claim makes a swift journey to the insurance company to get processed and paid.
Myth #2: If most of the information is correct, then the claim will get to the insurance.
Truth: The clearinghouse may catch any inaccuracies before it sends the claim to the insurance company, and in the event your claim does make it through, insurance companies will find any reason to deny your claim. If you are not using a clearinghouse or do not know which clearinghouse you are using, we would certainly suggest finding a clearinghouse ASAP, and you should be working in the clearinghouse DAILY! Inaccuracies and incomplete information is a sure-fire way to have your claim immediately denied. There’s no argument that the day-to-day at the front desk can get hectic and things can feel rushed, but taking the time to enter the patient’s information into the software correctly the first time is one of the single-most important things you can do to ensure your claim is paid. Correct data entry is the golden ticket to paid claims.
Myth #3: Once I batch a claim, it will be submitted.
Truth: Batched claims are essentially dental claims that are in line to be sent to the insurance company. Once a claim is batched, it manually needs to be exported to a clearinghouse that will then send it to the insurance company. Batched does not mean sent. Let me reiterate that you should definitely be using a clearinghouse to send your claims.
Myth #4: Claims go from my office to the insurance company directly.
Truth: Once you batch your insurance claims in your software and manually export them, the claims then do not go directly to the insurance company. They first go to your clearinghouse. A clearinghouse is a middleman between your office and insurance companies. It’s an important distinction because your clearinghouse is what makes electronic claims work so efficiently. They are the aggregator of all your data, they scrub all the information for inaccuracies and most importantly ensure your claims make it securely to the insurance companies. They are also the entity that reports any rejected claims back to your software and gives you the opportunity to fix it for resubmittal. Know your clearinghouse. They make your life a lot easier than it would be without them.
Myth #5: Clearinghouses automatically know where to send my claim once it’s received.
Truth: Clearinghouses are wonderful, yes, but they aren’t all-knowing. The clearinghouse relies on what’s called a Payor ID to filter and shoot the claim to the correct insurance company. Payer IDs are 5 digit/alpha characters unique to each insurance company. If you have the wrong Payor ID entered in your dental software for an insurance company, the electronic claim will not get there.
Myth #6: Attachments for major and basic services are automatically included with claims.
Truth: Dental software does an amazing job at organizing and maintaining all practice’s patient and claim information, but it’s up to the admin team/billing company to pull data from the software when claims (usually major and some basic services) need evidence for support in order to be approved. This support comes in the form of attachments like x-rays, periodontal charting, chart notes or narratives.
Are there any other dental claim myths you can bust for us in the comments? When light is shed on these nuances and assumptions it makes the claims process a lot easier.
– Josh Smith