No matter how carefully a dental claim is filled out upon submission, there’s always a chance it can get denied. There are several reasons why this could occur.
A clerical error or change to an insurance policy that was unknown to the patient are a couple of possible causes.
An acceptable claim, or “clean claim,” includes the appropriate form, correct coding, provider details, attachments and patient information and is free of any clerical errors without missing data. Most dental offices strive for this standard every time, but can still fall short on occasion.
Repeated denials can frustrate staff and divert resources from other important dental office functions. That’s why it’s important to implement a strategy that reduces errors and streamlines this billing process to receive proper and timely reimbursement.
Using the following checklist of standard items can reduce the stress around the office and increase the success rate of dental insurance claims for reimbursement.
Updated, current patient information
The connection between patients and whoever is information collection is a major factor in reimbursement. The person or computer-assisted technology must accurately capture patient data.
Dental offices can set up a system that makes the most sense for their workflow. Additionally, information should be verified more than once before appointments to ensure accuracy and ease of claim processing. For example, requesting verification whenever patients make an appointment. Full name, birthdate, address and insurance information are key pieces to input and verify whenever opportunities arise.
A lot of claims are denied due to outdated patient information, so double-checking information at every opportunity can confirm patient data and eliminate the risk of a rejected claim due to incorrect or outdated information.
Use of correct forms
There are some instances in which dental offices will need to fill out a medical form instead of a dental form. Oral surgery, trauma or pathology are some of the procedure types that will require a medical claim form (CMS 1500).
Making this determination is not always clear cut, and can be the root cause of claim denials.
Out of an abundance of caution, dental offices should make it a habit to double-check which form is needed with a simple phone call to the medical and dental insurance companies. It will be important to know since some medical claims have a shorter filing window than dental claims. Getting it right the first time becomes a necessity given the time constraints.
Correct billing entity
Along with correct patient information, the full inclusion of provider details is crucial.
When verifying personal information, dental offices should make sure that insurance information is correct, including the name of the insurance provider, company address, ID number and member’s date of birth. If the date of birth is different, then taking note of the name of the employer, group ID number and phone number of the insurance company is needed.
The patient’s coverage must also be active and changes to policies must be reflected in the system, as they could impact coverage. Insurance verification should be a routine step in the dental office workflow.
Necessary attachments and documents
Depending on the type of dental service or procedure, various attachments and documents will likely be required to move the claim forward without interruptions.
Making notes that reference other documents can be insufficient. With so many things going on with patients and their dental care, the details of submitting required documents can get overlooked in the shuffle. X-rays and intraoral photos are examples of appropriate attachments and documents needed for dental claims.
As a safety net, dental offices can adopt a policy of over-explaining and assuming that related documents will always be needed. Staying updated on procedure codes that indicate required supplemental information is another easy-to-follow tactic.
Remote billing as a solution
Dental offices can get paid faster, use their current claims system and receive all the support they need with remote billing services. With a team of specialists working in the background, dental teams can ensure prompt and accurate payment of their claims.
Claim denials are costly, eat up valuable time and can even divert attention from what matters most. The patient experience is a top priority and, with remote billing, it can remain that way.
Contact us today with any questions or for a risk-free assessment.