How to Avoid Claim Denials

Avoiding Claim Denials

One of the more frustrating aspects of dentistry is simply dealing with insurance companies and claim denials. Having to deal with dental insurance billing is such a hassle, especially when claims are delayed or denied entirely. Once you realize how easy these mistakes are to make, you’ll also see how easy they are to fix.

Incorrect Codes

In order for a dental claim to be processed properly, it’s necessary to include the correct, current code set to identify the diagnosis, services rendered, and procedures performed. Common mistakes include: confusing codes, forgetting them entirely, or submitted an “unspecific procedure” instead of using a definitive code.

Outdated Forms

For a smoother, and possibly quicker, process, always use the most recent version of claim forms.

Incomplete or Missing Information

This might seem like a no-brainer, but it’s one of the more common ways that dental insurance claims are denied. Always double check that all slots and blanks have been accurately completed.

Not Reviewing Patient Benefits

This goes hand-in-hand with the previous issue. It’s good practice to have your receptionists ask for a run-down of the patient’s benefits; although their insurance company may be the same, the benefits and/or group number may be different.

Unreadable Information and Files

As insurance companies and dentist offices transfer to electronic information, a common problem that arises is unreadable information/files. If the writing is too light or smeared or simply illegible, this can result in insurance claim delays. When submitting x-rays or charts, be sure to send the correct version; also make sure that they’re “mounted, labeled (right/left), and readable.”

Missing Tooth Clause

In this situation, a patient comes into your office with a missing tooth, claiming that he has dental insurance. You handle the situation and file the appropriate insurance, but the insurance company denies the claim because “the missing tooth was extracted prior to the patient’s dental coverage and its replacement is not a covered benefit.” The best way to avoid this issue is knowing the patient’s benefits before doing anything, especially complex procedures.

Contractual Denials: Clinical and Limitation

Contractual Clinical Denials occur simply because some contracts don’t cover certain services; usually, non-coverage services include cosmetic procedures. Contractual Limitation Denials are delayed or denied due to limitations in the contract based on age, frequency (how much time must pass before doing more procedures on the same tooth), or waiting periods.

No Explanations

If you can’t explain or document a reason why a procedure needs to be done, chances are slim that the insurance company will approve the claim.

Student Verification

Inadequate documentation of a student’s status often leads to denied or delayed claims; ask your carrier to gain a better understanding of what information you’ll need.

Trying to Juggle Everything

A very common issue with dental insurance is simply a lack of response from the office. Another issue is duplicate services: Instead of following up about an older, unpaid claim, another claim is filed. We understand how busy a successful dental office is (and also how easy it is for insurance questions to get lost). That’s why we’re ready to help avoid claim denials and increase your collections!

We know the most common dental billing issues that plague most offices and our billing experts are passionate about helping you avoid the headaches of dental insurance billing particularly when it comes to appealing dental claims. Our dental billing outsourcing services increase your production, maximize your profitability, and we handle any appeals/denials to save you the headaches.

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