In Dental Billing

Like many dental offices, you may have just seen a spike in your insurance aging report. Claims just don’t seem to be paying like you want them to, and your collections are fluctuating each month. This is worrisome, to put it lightly. But what causes this?

Because we are self-proclaimed “dental nerds” at Dental ClaimSupport, we actually enjoy researching claims. We have seen every single reason a claim does not process or pay that will inevitably increase your insurance aging report. This report isn’t necessarily “fun” to work on, but if you treat it as a game or challenge, you may change your mind on the matter.

In this article, we aim to shed some light on why claims actually show up on this report. After reading this article you will understand what makes up your report and the various ways you can eliminate these claims in the future.

Reasons a claim is on your dental insurance aging report

In a perfect world, you want to research claims on insurance web portals. It’s quicker and more efficient. Web portals have come a long way since being introduced over a decade ago. However, if you were to call the insurance payor for follow up on the claim status, you will most likely receive one of these four responses from an insurance representative.  

  • The claim is not on file
  • The claim was denied as a “no pay”
  • The claim has been paid but payment is not posted
  • The claim needs additional information

Let’s dive into each one of these and provide some examples.

The dental claim is not on file

There are numerous factors that can affect your dental claims getting to the insurance company.   Properly setting up your 2019 ADA dental claim form is the first step to ensuring your claims are being sent correctly. Other reasons a claim may not be on file may be incorrect information such as:

  • Data entry errors in your dental software
  • Insurance verification was not performed
  • Wrong insurance company
  • Wrong payer ID
  • Clearinghouse issue
  • Credentialing issue
    • Network issue
    • Treating location issue
    • Mailing address issue
    • Associate doctor not added to a practice location 

Example:  A claim may not be on file because a patient’s date of birth is incorrect in your dental software system. This is a basic example of a data entry error that could have been avoided.

The dental claim was denied as a “no pay”

Your claim may be denied as a “no pay” based on the provisions of the patient’s dental plan. Each dental plan has limitations and exclusions. A “no pay” means that these claims were processed correctly but no payment was sent because of these various, yet common exclusions and clauses. Below are just a few of the common reasons for claim denials:  

  • Frequency limitations
  • Age limitations
  • Deductible
  • Annual max
  • Waiting periods
  • Missing tooth clause
  • Replacement clause
  • Inclusive services
  • Non-Covered services
  • Timely filing

Example:  A “no pay” received due to frequency limitation for a patient’s 3rd cleaning of the year. The insurance plan processed the claim correctly but denied the claim due to the plan only covering 2 cleanings per year. 

The claim has been paid but not posted

When we take on new clients, we often see claims that have been paid but not posted to your dental software.  

If you are signed up for multiple EFTs, this seems to happen more often than receiving check payments from insurance companies. This means that you have already been paid for a claim via direct deposit, and a team member did not post the payment into your dental software to close the claim out.

Therefore the outstanding claim is still sitting on your insurance aging report in error. This also inflates your insurance aging report because your software still expects a payment even though you’ve already had the funds deposited.

This is a common error seen in many dental practices that accept EFT payments because the insurance is no longer sending copies of the Explanation of Benefits (EOB) by mail. 

Your insurance coordinator is required to visit the multiple insurance company websites each day to discover if and when you have payments hitting your bank account. This can be time-consuming and if your insurance coordinator does not have access to your bank account they won’t be able to see if a payment was deposited or not.

This type of claim is the main culprit to an inflated insurance aging report. The silver lining is these are the absolute easiest claims to remove from your report. Technically, all have already processed and/or paid. Your dental team just needs to retrieve the EOBs and post them to ledgers accordingly.

The claim needs additional information 

Many times when a claim can’t be auto-adjudicated, meaning the insurance company computer system automatically receives, processes, and pays a claim, it’s because the claim requires more information.   

Additional information comes in the forms of:

  • X-rays
  • Perio charting
  • Narratives
  • Coordination of Benefits (COB) information
  • Crown seat or placement dates

Example:  Insurance denying a claim due to not receiving an x-ray to accompany the claim for a crown.

What are other factors that can affect my aging report?

There’s more? You bet. Aside from what we have already discussed, there are some other reasons that claims end up unprocessed or paid. These are a little different from the reasons listed above, as the denials, unposted claims, or requests for additional information stem directly from these issues.

Credentialing issues and adding providers may cause a delay in payments

Credentialing is mostly an issue when new associates join an existing practice and proper credentialing was not performed. Credentialing involves getting a provider in-network with an insurance company. 

When starting up a new location or adding an additional provider to a current location, the credentialing process needs to start as early as possible.  Most insurance companies take anywhere from 8-12 weeks to complete a credentialing for dental providers.

Adding providers to a Tax ID can also create issues with claims payments. Adding a provider to your dental office is not to say you are credentialing that provider with an insurance company. The two are different. However,  you still need to provide the necessary paperwork to insurance companies informing them of a new provider at your location. Insurance companies have to update this information in their databases in order to process dental claims

If a provider has not been added correctly or credentialed properly, claims may go out with incorrect information, causing claims to deny. This incorrect information could be location NPI 1 versus NPI 2s, or even social security numbers instead of Tax IDs.  

Correcting credentialing issues takes longer than you might expect, however fixing these issues are essential to your dental practice moving forward.

EFT issues may cause a delay in insurance posted in software

EFT issues can be corrected pretty quickly. These are typically paid claims that are not posted in your dental software, as we discussed above as a reason claims are on your aging report.. These can be posted immediately, however you need to involve your accountant because your balance sheet may likely be affected if claims were paid in previous months or even the previous year.  

Clearinghouse issues may cause a delay in sending dental claims

No matter the software you are using, whether it’s Open Dental, Dentrix®, Eaglesoft®, Curve, etc. you are still utilizing a clearinghouse to get your claims from your software to the insurance company. Your dental claims may not be on file due to a clearinghouse issue.

Proper setup of the software is essential to getting insurance claims paid in a timely manner. These claims will show on your dental insurance aging report, however, they likely never made it out of your clearinghouse. If your office information, such as billing location, rendering provider information, and  TAX ID are not set up properly in your practice management software, the claims will not make it through the clearinghouse. 

Sending the claims again will not work without proper research as to why the claims are being held up in the clearinghouse in the first place. This must take place prior to the claim resubmissions.

How do I find my insurance aging report?

Depending on who you are, you may think the following is a “chicken before the egg” type comment. 

Is it good to know how to run an insurance aging report before you understand why claims actually show up on it? Truly it doesn’t matter, because they are BOTH equally important.

Begin your journey to higher collections and lower insurance aging. Don’t wait until your report is unmanageable. Set a schedule, and get to work! For whatever dental practice management software you use, you need to understand how to run a dental insurance aging report and comprehend it.

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