Why Your Dental Insurance Claims May Be Denied

Is your patient eligible for benefits?

Many claims are submitted for patients who are not eligible for any payments(their benefits have run out or coverage is terminated). Rather than file a claim or predetermination and wait weeks to find out that they have no coverage you’ll be billing the patient for all costs, check a patient’s eligibility before-hand. Depending on the insurance company you can often check either by phone, using their IVR or even going online.

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#1 Reason Dental Insurance Claims Are Denied

Did you know that the Number One reason claims are rejected by insurance companies is that the wrong group number is placed on the claim?

If you’re filing electronically, always make sure that all information is accurate in your software.

If you’re using paper claims, be accurate and legible. More insurance companies are using optical scanning (OCR) to input claims into their system and a smudged entry can be mis-read.

Whenever a patient is starting a new series of visits, confirm that their correct insurance information. They might have switched jobs or benefit levels in the interim and your old information might not be accurate.

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Correct CDT coding of dental insurance claims

If you use a code that has been discontinued, that service will usually be denied by most payers. (For example, it has been discontinued, some offices continue to submit the procedure code D4220 – gingival curettage)

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Visit us at The Huskin Group about our dental insurance and practice management services.

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Correct CDT coding of dental insurance claims

Use as specific a code as you can find. If your procedure is not listed, you can use the last code (unspecified procedure, by report) in each grouping, DX999, but include a narrative to explain what you did.

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Visit us at The Huskin Group about our dental insurance and practice management services.

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Correct CDT coding of dental insurance claims

A mistake we see is in their haste, some offices will mis-code retainer (abutment) teeth as pontics and visa versa. This can lead to denial of the claims and return to the office for correcte coding. A lot of time can be wasted as a result of this simple avoidable mistake.

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Visit us at The Huskin Group about our dental insurance and practice management services.

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