A dental practice exists primarily to provide quality care and service to patients. However, to remain sustainable and deliver quality care continuously, the practice needs to remain profitable, with cash flows consistent and positive. Following a few proven steps in dental insurance billing can help to maximise revenue for a dental practice.
For many dental practices, there are generally cases of insurance claims getting rejected. This, in turn, affects cash flows and a consistent revenue stream. When a claim is denied, the dental team must submit a corrected claim to ensure it is processed and reimbursed. Nearly 80% of Americans are covered by dental insurance, but 15% of insurance claims submitted by dental practices in the USA get denied for multiple reasons.
The dental team must be adequately trained on how to handle a claim denial through the timely submission of these claims. The team must note that the process of sending a corrected dental claim can vary across insurance companies.
When faced with a claim that gets rejected, the dental team needs to resubmit a dental insurance claim that is precise and correct all errors that were present at the time of filing the original claim. Possible errors include typographical errors, incorrect patient information or billing amounts, and incorrect CDT codes.
Hence, a corrected dental claim is vital for a dental practice as it ensures that the insurance company gets the revised claim with precise information to enable the practice to get duly reimbursed for the service rendered. When done promptly and accurately, the dental team can prevent any delays in payment.
Many insurance firms impose deadlines for the filing of claims. This can range from three to six months, and hence, the team needs to submit claims promptly and accurately.
A few instances why a dental practice needs to send a corrected dental claim.
When the dental team submits a claim with careless errors, such as incorrect patient information or policy numbers, a corrected claim must be filed.
Claims submitted with the incorrect code entered for the treatment rendered to the patient will result in the claim being rejected by the insurance company. The team needs to revert with a corrected dental claim with the right CDT codes.
There is a chance that the dental team mentions the wrong date due to oversight, which results in the claim being denied. Such an incorrectly reported date needs to be resolved by sending a corrected claim.
The team will have to send a revised claim to the insurance company in case the amounts charged to a patient have not been accurately mentioned. The team might also have to attach documents that include radiographs or clinical notes with the corrected claim for procedures like scaling and root planing.
The dental team needs to prepare a corrected claim when the original claim sent to the insurance company has been denied due to errors or lapses in the file. The idea is to rectify all errors and submit a clean and precise claim again for prompt reimbursement.
An appeal is an action taken by the dental team when it believes that the claim submitted to the insurance company is accurate but has been partially reimbursed or rejected. The process of appealing implies giving extra supporting documents or clinical notes to strengthen and support the original claim sent by the team.
When a claim gets rejected, the team needs to be careful and follow some basic guidelines before submitting a corrected dental claim. It needs to specify that the rectified claim submitted is a corrected claim by ensuring a citation of the original claim number. The team needs to label the submissions as a ‘corrected claim’ on the claim form across electronic and paper submissions.
Claims are rejected due to errors or lapses made by the dental team. One needs to ensure that the corrected claim being submitted is accurate and that all necessary information or documents have been duly provided. The team must attach these documents again, even if the same were submitted during the original claim submission.
Based on the requirements of the insurance company, the dental team needs to send a corrected claim either through electronic or paper submissions.
Many insurance companies prefer electronic claim submissions as this reduces the need for paper and saves time. Submitting a claim electronically can be done by using the HIPAA 837 standard transaction system.
The Claim Frequency Code ‘7’ needs to be used for sending a corrected claim. The team needs to incorporate the original claim number in the designated field that will connect the corrected claim to the initial submission. If needed, a few explanatory notes can be added that highlight the corrections made in the resubmitted claim.
There are several benefits of using electronic submissions. It saves time and facilitates faster processing of the claim. This helps to lower the time taken for reimbursement by the insurance company. There are real-time validation tools available, and the team can use them to remove errors, if any, prior to submitting the claim. The team can also track the status of claims more easily.
The usage of a paper submission process has been on the decline. Some insurance firms accept paper submissions, and the team needs to file the claim appropriately for the claim to get cleared and reimbursed.
The team needs to highlight ‘Corrected Claim’ at the top of the claim form. The Claim Frequency Code ‘7’ needs to be used for sending a corrected claim. The original claim number must be mentioned on the new claim form. All relevant documents and notes must be attached.
Paper submissions take a longer time to get processed by the insurance company. The submissions can get lost or misplaced, and this wastes additional time. A cost for postage and printing also needs to be borne by the dental practice.
Whether using electronic or paper submission, the dental team needs to confirm all data entered before sending the corrected claim. All notes and documents and notes must be attached to the corrected claim. More importantly, it needs to be done before the deadline outlined by the insurance company.
Cash flows are crucial for a dental practice as this helps it to stay sustainable. Submission of corrected claims is an important part of the billing process. The dental team must ensure the corrected claim is properly reviewed before submission. The team can submit claims via electronic or paper submission. The claims need to be properly checked as this helps to avoid delays in reimbursement and keeps cash flows ticking.
Capline Dental is a leading provider of end-to-end services to dental practices of all sizes in the USA and can be reached at info@caplinedentalservices.com
