When a dentist provides services to a patient, they expect to receive reimbursement for that service. However, whenever a denial is issued by the payer, it calls for the claim to be adjusted. These denials can be appealed, depending on the reasons.
At Capline, we have presented the most effective actions that should be taken to handle a claim adjustment.
Service Is Not Covered
If the claim gets denied because a service wasn’t covered by the payer, you don’t need to adjust the claim, however, they are to be billed to the patient at the time of service received. If you adjust the claim, that means you are providing the service free of charge. The responsible party for a service not getting covered would be the patient himself not the dental service provider.
Late Filing of Claims
Timely filing denials are quite common when submitting a claim that was previously denied. The only way to counteract this is when you resubmit a corrected claim, you provide the payer’s previous claim number that was issued on the denial. This will help see that the original claim was filed in a timely manner and providers won’t be denied.
No Prior Authorization
If a claim gets denied due to not receiving prior authorization, the first thing you should do is to check with the office to make sure they actually did not receive prior authorization. If they receive, all you should do is simply add the code and re-file the claim.
Sometimes when a procedure is billed twice, the payer may mistakenly assume that it is duplicate. All Thanks to the new codes ICD-10, that cleared up some of this confusion.
If you are still worried about claim adjustment, talk to our experts today who will be happy to assist you. The above given are some scenario that you could receive as claim adjustment. So, take the guesswork out of dental billing, saving your practice’s time and money and turn to Capline’s team of billing experts for your practice.