Why attachments are important in dental insurance claims

When you send a dental claim off to the insurance company, you send it with confidence that it will pay, not be denied. So, when it is denied, you can’t help but feel frustrated and wonder, “What went wrong with that insurance claim?” A great first step is to check what attachments are needed for dental claims.  

Chances are, if the patient and insurance information is all correct, maybe the claim just needed more information and you forgot to attach specific supporting documentation to your claim.

At Dental ClaimSupport, we see claim denials due to a lack of supporting documentation often enough that we decided to address it here. As a remote billing company, we always advise the in-house team to “over-explain” themselves when it comes to attachments and narratives, because the more information you provide to insurance companies, the less likely they are to deny reimbursement. 

In this article, you will learn how specific supporting documentation is crucial to getting your dental insurance claims paid. This knowledge will help your dental team reduce the denials and collect more revenue from your billing process - whether you’re outsourcing dental billing or doing it in-house.

What is supporting documentation on a dental insurance claim?

Supporting documentation is the evidence attached to an insurance claim, which tells the insurance company why the dental procedure was necessary. It’s proof that services were needed. 

Supporting documentation can come in the form of:

• X-rays 
• Periapical (PA)
• Panoramic (Pano) 
• Full Mouth X-ray (FMX)
• Intraoral photos
• Clinical notes (examples below)
• Charting
• Narratives 

Certain procedures require different types of documentation, as well as coding. Here are a few examples of procedures that require supporting documentation, including clinical notes examples:

These procedures and their specific documentation is a lot to keep up with, and it is common for dental teams to forget to add all of the details.

Here’s a simple chart to help you quickly check if attachments are necessary:

How do you know when to include attachments on your dental claim?

What happens when supporting documentation or attachments are missing on an insurance claim?

Short answer: your insurance claim is more likely to be denied. 

Supporting documentation is key for a clean claim. When we say “clean claim,” we mean a claim that has everything it needs to be reimbursed by insurance: accurate patient information, proper coding, and of course, supporting documentation. 

Insurance companies look for any reason to deny your claims or downgrade your procedures for lower reimbursement, so with your due diligence, you won’t be giving them a reason.

If this is so obvious, why do these claim details get forgotten?

Sometimes claim details are forgotten just because the dental team gets caught up in the routine of the day, especially if they are busy, and neglect to attach certain x-rays or intraoral photos. 

Or other times, they don’t realize that an x-ray is insufficient and need to attach an intraoral photo to show why dental services were needed. Sometimes an x-ray doesn’t show what the naked eye can see. 

Then, of course, there are some patients who cannot handle having the camera mechanism in their mouth. This specifically, is something you should add to your claim in the clinical notes. 

The more details are missing on your claim, the more likely it will be denied. Specifically, consider taking intraoral photos of the original condition prior to treatment. 

This is important for three reasons: 

1. It provides evidence of medical necessity.
2. It documents your clinical findings before any work is done. Showing the original condition is essential in case you need to send in an appeal. 
3. It helps you educate your patients so they can see and accept the need for treatment.

You can always still fight insurance on this, but it does get difficult when you do not have effective documentation. 

You should also always include documentation on claims for legal reasons

Obviously, your practice getting paid is important. But including properly supporting documentation on your claims, and keeping accurate records of your patients’ health on file can also keep your practice covered legally. 

For example, let’s say you treat the patient, but you don't have documentation to support what you did, and then the insurance denies the claim. Then the patient is notified by their insurance that the claim was denied because they “didn’t need the procedure.”

Now the patient, who doesn’t know how insurance denials work, might be alarmed that they paid for unnecessary dental work.

We’ve seen this scenario play out, and it can lead to an ugly situation. If you always have sufficient documentation, you should have no reason to worry. It’s direct proof that can help prevent disputes from escalating, or protect you if they do. 

Avoid denials and collect everything you’ve earned from insurance companies

As we mentioned, insurance will do anything they can to deny your claims. It’s important that you always remember to provide ample documentation in images and in the clinical notes, making sure no stone is left unturned as to why the procedure was necessary. 

Dental ClaimSupport can always advise your in-house team with other tips to avoid insurance claim denials. And of course, our customers don’t waste time appealing your denied claims because that’s included when you outsource dental billing with us. 

To learn more reasons your claims could be getting repeatedly denied by insurance, read our article, “10 reasons your dental insurance claims are being denied” in order to learn to avoid them and collect more.