How To Amend A Dental Claim Submission Denial

How To Amend A Dental Claim Submission Denial

Avoiding claim denials is challenging, but with proper handling, dental offices can provide quality patient care and efficiently respond to claim rejections. Submitting dental claims takes time, often outside regular hours. Capline Dental Services is here to assist in filling out and submitting dental claims, improving your dental accounts receivable.

In this article, we discuss strategies to avoid and resolve claim denials, ensuring appropriate benefits for both patients and the dental practice.

Use Correct Procedure Codes:

When a dental claim is denied, consider the following:

Am I using the correct CDT manual? The CDT Code, published annually in the CDT manual, changes regularly. According to HIPAA, the correct version of the CDT Code is effective on the service date, regardless of when the claim is submitted. For example, for a service provided in December 2022 and a claim submitted in 2023, the applicable procedure code set is CDT 2022.

Are the procedure codes correct? To amend procedure codes, use the complete nomenclature with descriptors per the current CDT manual. Some dental software may exclude descriptors, increasing the chance of claim denial. For instance, D0160 has a descriptor, whereas D2999 does not. Each requires a separate narrative to prevent errors. A good narrative clearly describes the procedure, extra time or material needed, the clinical condition, and any relevant

information. A quality check before claim submission ensures accuracy.

Avoiding Claim Denials through Submitting Claims Electronically:

Using HIPAA-compliant standard electronic dental claim management systems can increase claim acceptance rates. Partnering with a company like Capline Dental Services, specializing in dental accounts receivable, can improve ROI and allow the practice to focus more on patient services.

Avoiding Claim Denials by Outsourcing Dental Billing Submissions:

The primary goal of a dentist is patient care and receiving reimbursement for services rendered. Another goal is increasing patient numbers, which can be challenging if staff are occupied with filing claims. A thriving dental office doesn't entail high staff turnover or overburdened employees.

At Capline Dental Services, we handle billing tasks to improve overall revenue. Dental offices often worry about losing control when outsourcing, but our real-time reporting provides insights into claim denials, insurance aging reports, interactive reporting, denied claim appeals, dental insurance verification, insurance fee schedules, and patient billing services.

Avoiding Claim Denials by Verifying Covered Services:

Claim denial due to non-covered services requires adjustment, with the patient being the responsible party. Billing at the service time confirms that the patient has received the service.

Prior Authorization:

  • If a claim is denied due to a lack of prior authorization, first confirm if the office has received it. If they have, add the code and re-file the claim for adjustment.
  • Timely Filing Dental Claim Denial:
  • Timely filing of denied claims is common. To amend them, resubmit the correct claim with the previous claim number to verify the original submission.

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