How to Appeal a Denied Claim

There are various reasons for carriers to deny an insurance claim. The reasons for denials can vary depending on the payer, however, the first thing to consider is to know why the claim was denied? The good news is that appealing a denied claim is much easier.

Preparing to Appeal a Denied Claim
Once you are confirmed about the reasons for denials, there are some simple steps you can take to appeal a claim denial.

• You need to make sure that all the information entered is accurate and clear.
• Make sure you have all the required information related to procedure, diagnosis and treatment plan
• Have an understanding of the appeal process for specific insurance or payer you are submitting the appeal to.
• Verifying the guidelines according to the payer’s policy

Reasons for Claim Denial
One of the well-known reasons for claim denial is submission of an inaccurate information. Therefore, attention to detail is of utmost importance for billing and coding. Submitting the right claim for wrong treatment is quite common and this happens because the practice is already occupied. So, there are more chances of mistakes. A thorough and detailed system of checks will go a long way in resolving errors.

Your dental practice can avoid denials by asking these simple questions:

• Are the identification numbers, group numbers, policy numbers, and any other identifiers correct and complete? 
• Is the physician’s provider identification number correct? 

Another common mistake is incorrect coding or treatment diagnosis. It is important to use the most up to date codes. Another way to avoid mistakes is avoiding the confirmation of benefits. The patient’s insurance benefits should be verified before the visit is scheduled.

At Capline, our experts can help you appeal a denied claim. We work relentlessly to solve these problems. Get in touch with our experts and say goodbye to claim denials and rejections.