Amongst various challenges, the issue of not getting dental claims paid happens to be the most frustrating one. Sometimes, it takes a significant amount of time to process claims. And it turns your frustration 10 times worse if you don't get paid for those claims, or in more severe cases if your claims are denied entirely. As experts in dental billing, we have known the significance of monitoring and resolution of claims to save time from unnecessary waste.
So, this blog will take you through the usual reasons why dental claims go unpaid and provide you with ideas on how to deal effectively with those issues.
Claims refer to the forms the dental practices submit to insurance companies on behalf of a patient, requesting compensation. What they show are the services they have conducted, fees charged, and relevant liabilities from the patient and the insurance. Even when all seems well, claims remain unpaid. Let's see what are the main causes of this scenario and how a dental billing company can avoid making such errors.
Among the numerous key reasons why dental claims remain unpaid is incorrect or inappropriate data. It will only be possible for the insurance companies to successfully process the claims if there is accurate data. The most significant reason why many claims get denied is because of errors in patient demographics, procedure codes, or details of insurance.
Solution:
You can invest in advanced dental billing software. It allows the information of the patient to be verified and then cross-checked before claims are submitted. Also, constant training on billing procedures by the staff will ensure that claims are as few as possible without errors. If you can outsource to a professional dental billing company that specializes in accuracy in claims, so much the better.
This makes patient eligibility often fluctuate due to changes in employment or policy as well as changes in insurance cover, and therefore, there is frequent denial of claims because a claim may be submitted without proper verification that is required of the current status of the patient's insurance cover.
Solution:
Check patient insurance eligibility and coverage limits before doing any procedure. Many dental billing software platforms allow for real-time eligibility checks, making it possible to verify whether the patient's insurance is active and covers procedures being done. This will save your practice from just wasting time on unpaid dental claims for services or even wrongly denied reimbursement.
Incomplete or insufficient documentation may result in claims denial. Most dental claims require additional documentation, such as radiographs, periodontal charting, or narratives, to justify certain treatments or procedures. Denial may be made for missing or vague documentation.
Solution:
It will attach all documents required in claim submission, and you should be educating your staff properly so that they can prepare proper narratives and attach supporting evidence. A dental billing company will streamline the whole process, ensuring all attached documents are legible.
There are several reasons for unpaid claims, namely that the claims were late submission to the insurance company. Every insurer has its deadlines, and windows that are missed lead to rejections of claims.
Solution:
Set internal deadlines for the submission of claims. This should be within 24 to 48 hours immediately after the procedure. You can further minimize your chances of missing out on a critical cut-off date using dental billing software. Your billing team must keep track of your unpaid dental claims and have a system to follow up on timely submissions.
The other very common issue for unpaid dental claims is coding errors. Failure of the procedure codes to show the services offered or the diagnostic codes that have been done inaccurately may result in the rejection of claims by the insurance providers.
Solution:
Proper and up-to-date coding will ensure that the claims are accepted. Train your staff on the latest CDT codes, and also consider checking into your dental billing software implementing automated features for coding, so it ensures those human slips are not there, and their claims ensure they pass through because they meet insurance coding standards.
Managing unpaid dental claims can be a stressful and overwhelming process. However, by eliminating common issues such as information being incomplete, eligibility verification being denied, coding error, or documentation missing, the claim denial rate may drop to a significant level. This is why investing in dental billing software and partnering with a specialized dental billing company is an effective way of streamlining the claims process to minimize errors and ensure prompt payments.
Further, by being proactive and using the various applications available to handle all the complexities of billing, you can minimize your liability from unpaid dental claims and see that your dental practice gets back on its feet and running more efficiently.