How to solve Claim not on file issue in Dental Billing

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Dental insurance services including verification, claim submission and approval, are a game-changer, when it comes to the satisfaction of dental patients. That’s the reason a lot of dental practitioners choose to outsource dental billing and insurance services. However, it’s not always an easy job for dental services providers to complete the claim submission & approval process. One of the most recurring problems among denial management scenarios, for dental billing and insurance services experts is – “claim not on file” status. The status not only just halts the claim submission and approval process, but also makes a patient wait longer than usual to get the approval for the claim. It’s a problem not just for dental services providers and dental practitioners but for patients also. Let the article guide what exactly needs to be done when “claim not on file” happens?

It’s been an amazing experience for both patients and dental services providers since the introduction of electronic claim submission. The mechanism saves time & effort and the rate of claim approvals is also quite high. Patients get timely approvals and they go home post treatment happily. However, many insurances are still not willing to participate in the electronic system which causes the “claim not on file” issue. The issue seems to help the insurance companies delay the claim payment. 

The cause for – Claim not on file issue:

Billing and insurance experts send clean claims to the insurance company. When the claim is not resolved for over 30 days, the experts contact the insurance company to find out the reason behind the same. The question they have is, “why is the claim amount not paid yet?” And, the usual reply they get from the insurance company representatives is, “Your claim is not on file.” This usually happens when the claims are required to be mailed because the insurance is a non-electronic payer. 

Mailing claims always create some sort of problem. Sometimes, claim files are not received or sometimes misplaced. This either misplaces the patient’s information or it doesn’t reach the right address. Whatever is the case, the patient has to wait and the dental services provider needs to put-in extra efforts to bring the claim approval process back on track. So, it becomes a responsibility for both dental practitioners and dental services providers to make sure that the problem does not occur very often. And, if it does, they should know the exact solution to it.  

Solution to – Caim not on file: 

As a dental billing and insurance expert, you must be aware of certain things before you start resolving the issue. As soon as you get the “claim not on file” status, you need to verify the mail address of claim, eligibility status, filing period, fax number, doctor’s referral letter, date limit, whom to fax the claim, and fax number. 

  1. The solution to the problems begins with the verification of the patient’s information with what insurance has on the file. If they haven’t received the claim file or it has been sent to some other address, it needs to be re-submitted. Verify the mailing address before doing that. 
  2. Second, the claim needs to be faxed to a supervisor. Verify the fax number first before faxing the claim.  
  3. Always wait until the fax is received or you get a supervisor’s contact information.  
  4. Also, check the patient’s eligibility status to verify the entitlement on the DOS. You should also be aware of the filing limit for the claim. 
  5. To avoid timely filing issues, get the claim on file via fax first.
  6. Now, do a follow up in a few days and submit the supporting documentation to the supervisor via mail. 

Professional follow-ups with the insurance company and timely submission of a claim with thorough verification of patient’s details can remove this one of the many denial management scenarios, “claim not on file.” The lesser the issues with claim approvals, the happier the patients would be!