Are you tired of the endless loop of getting one dental billing claim passed? We understand that dental billing is a tedious process that results in major revenue for dental clinics. Other than influencing the cash flow, claim denial even results in patient issues for the caregiver.
According to the National Association of Dental Plans, more than 70% of Americans have dental coverage. As a result, patients can receive compensation for their treatment costs. But when a claim is denied, it impacts both parties involved.
Dental Billing is different from medical billing so, the details and documentation required in it also vary. The first step in building the right plan to avoid dental billing claim denial is understanding what a dentist must have ready.
- The fee
- Both provider and patient information
- Subscriber information
- Clinical notes
- Attachment information
- Date of initial placement
For more details on dental billing, you can visit the ADA website.
Reasons For Dental Claim Denial By Insurance Companies
- Documentation Errors
More than 50% of dental claim denials occur because the details on the forms are incorrect, misrepresented, or not properly filled out. Before submitting the form, ensure details like dates, TIN, EIN, or SSN are all mentioned. (what about correct patient info or missing charts or X-rays?)
It must also be noted that the plan that the patient has an impact on the form details. A dental health practitioner must ensure minute details like this are filled in properly. If some supporting documentation needs to be attached, prior information about that will reduce the chance of claim denial.
- Outdated Forms
One more thing to note is that you must use the most recent form. Insurance companies usually update their forms based on requirements and new changes. If you fill out an old form, chances are that your claim will be held in processing. The best thing to do is, contact your insurance company and find all the details beforehand.
- Untimely Claim Submission
You should never be late with your dental claim form. The staff should be trained adequately or else, you might lose out on revenue. Another reason the insurance company can deny your claim is the late submission of the claim. The usual time is claimed to be filed within 90 days from the date of service. But to ensure you are not due, talk with your insurance company about their policies.
- Limitation Of The Plan
Every dental plan comes with limitations, frequencies, and exclusions. Some claims like reconstructive procedures even require pre-authorization. These limitations may be the maximum amount of the plan for a year/lifetime or even the number of times a particular treatment claim will be processed, maximum age, etc. Verify these details with the patient (Insurance instead with patient) to stay protected from the harms of dental claim denial.
- Missing X-rays and claims
As per the ADA, third-party claim payment due to missing X-rays is a concern. All the documentation that needs to be sent over to the insurance company, must be duly done as per the standard and required procedure. The CDA’s (California Dental Association) advice for saving little time is:
- Include a description explaining what the X-ray shows (explaining the reason for treatment)
- Printed format with a brief explanation that justifies the treatment and the claim.
- Proper labeling of the patient’s name and date on the X-rays
The chances for approval of your claim are slim if you cannot explain why a certain procedure was required along with the proof and explanation of the same.
- Coordination Of Benefits(COB) Issues
Certain patients may have more than one dental plan and both of those could be used to cover the dental procedures. Certain COB issues may act as a hindrance in claim processing. These are:
- Failure to submit an Explanation of benefits
- Incomplete COB information
- Inaccurate COB information, etc.
To prevent these, collect data about both primary and secondary insurance, and its coverage and other details along with patient verification. Once you know the primary and secondary payer, you can work to submit claims accordingly.
Hire a dental billing and revenue cycle management agency (there cannot be two keywords, we need to take one by one, either Dental Billing OR revenue cycle management as it includes two separate functions)
As a dental billing agency, we want dentists and their teams to focus on patient care and leave the billing to us. If all the steps mentioned above sound too tedious and complex, the best way is to hire a dental billing agency to do this work for you. Every aspect of the claim process will be handled by them, whether it’s communicating with an insurance company or submitting the claim form. Talk to our experts and get on board for the trial period to see the benefits of hiring a dental billing company yourself.
Email us at clemens@qodoro, or fill in the details at https://www.qodoro.com/contact