{"id":14629,"date":"2024-06-25T06:36:44","date_gmt":"2024-06-25T10:36:44","guid":{"rendered":"https:\/\/qodoro.com\/us\/?p=14629"},"modified":"2024-07-01T01:24:25","modified_gmt":"2024-07-01T05:24:25","slug":"most-common-reason-for-dental-claim-denial","status":"publish","type":"post","link":"https:\/\/qodoro.com\/us\/blog\/2024\/06\/25\/most-common-reason-for-dental-claim-denial\/","title":{"rendered":"Most Common Reason For Dental Claim Denial\u00a0"},"content":{"rendered":"<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Reading Time: <\/span> <span class=\"rt-time\"> 3<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span>\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"14629\" class=\"elementor elementor-14629\" data-elementor-post-type=\"post\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a819d80 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a819d80\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7644e21e\" data-id=\"7644e21e\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1f287ba3 elementor-widget elementor-widget-text-editor\" data-id=\"1f287ba3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\n<p class=\"wp-block-paragraph\"><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The fee<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Both provider and patient information<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Subscriber information<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Clinical notes<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Attachment information<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Date of initial placement<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">For more details on dental billing, you can visit the <\/span><a href=\"https:\/\/www.ada.org\/-\/media\/project\/ada-organization\/ada\/ada-org\/files\/publications\/cdt\/v2019adadentalclaimcompletioninstructions_v3_2022feb.pdf?rev=70d192ad312a47f285487c1d69de4190&amp;hash=8EFBBD50FA335262C463823E1CA83DFE\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">ADA website<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><b>Reasons For Dental Claim Denial By Insurance Companies<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Documentation Errors<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">More than <\/span><a href=\"http:\/\/www.dentistryiq.com\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">50% of dental claim denials<\/span><\/a><span style=\"font-weight: 400;\"> 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?)<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Outdated Forms\u00a0<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Untimely Claim Submission<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Limitation Of The Plan<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">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 (<\/span><span style=\"font-weight: 400;\">Insurance instead with patient<\/span><span style=\"font-weight: 400;\">) to stay protected from the harms of dental claim denial.\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Missing X-rays and claims<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">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&#8217;s (California Dental Association) advice for saving little time is:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Include a description explaining what the X-ray shows (explaining the reason for treatment)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Printed format with a brief explanation that justifies the treatment and the claim.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Proper labeling of the patient&#8217;s name and date on the X-rays\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Coordination Of Benefits(COB) Issues<\/b><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u00a0Certain 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:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Failure to submit an Explanation of benefits<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Incomplete COB information<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Inaccurate COB information, etc.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p>\n<p>\u00a0<\/p>\n<p><b>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)<\/b><\/p>\n<p><span style=\"font-weight: 400;\">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&#8217;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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Email us at clemens@qodoro, or fill in the details at <\/span><a href=\"https:\/\/www.qodoro.com\/us\/contact\"><span style=\"font-weight: 400;\">https:\/\/www.qodoro.com\/us\/contact<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p><span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Reading Time: <\/span> <span class=\"rt-time\"> 3<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span>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.\u00a0 According to the National Association of Dental Plans,&#8230;<\/p>\n","protected":false},"author":1,"featured_media":14650,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[75],"tags":[],"class_list":["post-14629","post","type-post","status-publish","format-standard","has-post-thumbnail","category-dental-billing"],"_links":{"self":[{"href":"https:\/\/qodoro.com\/us\/wp-json\/wp\/v2\/posts\/14629","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/qodoro.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/qodoro.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/qodoro.com\/us\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/qodoro.com\/us\/wp-json\/wp\/v2\/comments?post=14629"}],"version-history":[{"count":0,"href":"https:\/\/qodoro.com\/us\/wp-json\/wp\/v2\/posts\/14629\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/qodoro.com\/us\/wp-json\/wp\/v2\/media\/14650"}],"wp:attachment":[{"href":"https:\/\/qodoro.com\/us\/wp-json\/wp\/v2\/media?parent=14629"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/qodoro.com\/us\/wp-json\/wp\/v2\/categories?post=14629"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/qodoro.com\/us\/wp-json\/wp\/v2\/tags?post=14629"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}