Submitting dental claims is a pain point for many dental practices. They get denied for a myriad of reasons or some trivial mistake or some update in the patient’s policies. Whatever the reason, you deserve proper payment for the procedures that you have done. It can feel frustrating if the claim goes unpaid by the insurance.
This article walks through how to submit a dental insurance claim in the correct form to protect the financial health of the dental practice.
Verifying the eligibility of the patient before
The first step for submitting dental insurance claims starts with verifying eligibility ahead of time. This small step can save a lot of time and energy further. It is the regular step in the claim-submitting process. Many providers try to skip this process, but insurance verification increases revenue.
Before even the patient visits the office, get this step done to understand the patient’s insurance plan, active dental benefits, and all relevant details, such as:
Verifying eligibility is key to creating claims that pay. Your team will reduce billing headaches and paperwork. It will show the covered and non-covered treatments in the patient’s insurance coverage plan.
Correct coding as per the procedure increases the chances that the insurance company will pay for the treatment. Inaccurate coding declines the pay and has to start the process again to receive the payment. Refiling increases the claim processing time and the cost to the dental practice as refiling fees. The codes are published and updated by the ADA annually. Keep yourself informed continually and stay on top of the changes in the coding for maximum collection.
Correct patient information
First things first, make sure you are filing with the right insurer. When the patient calls the office to make a dental appointment, get some information from the patient, like full name, date of birth, address, and insurance information with correct spelling.
The pandemic has led to changes in employment with many patients and lapses in appointments. Once the patient is in the office, verify the details by looking at the insurance card or driver’s license. It seems straightforward, as, on the going, it can save you from errors that could cause delays in processing.
Include appropriate documents
Dental insurance companies require additional documentation as proof of the service performed was necessary. Just saying the clinical notes do not suffice the medical necessity of the procedure explaining why the patient needed the particular treatment. Attaching x-rays, charts, and intraoral photos helps you to justify the treatment and provide as much information as possible in the claim submission.
Always consider taking the correct size photos or the correct format to reduce the amount of back and forth. Show them the required pictures in their original condition to speed up the payment. Different CDT procedures require different types of attachments depending upon the annual updates.
Create, batch, and submit the claim with the respective insurer. Track the claims if certain days have passed. Nobody likes calling insurance companies for follow-up. However, it is the fastest way to expedite the process and get a timely reimbursement. The insurance company’s representatives help answer the question and resolve the claim issues quickly.
Do not let the insurers dictate your dental claims revenue, and make sure your claims make a swift journey to get processed and paid. Verifying insurance, inputting accurate patient information, and following up is the golden ticket to paid claims. Many claims do not even make it to the insurance company and get denied when they go to the Clearinghouse.
The Clearinghouse is a bridge between the practice and the insurer. Partnering with the Clearinghouse assures the quality of the standard procedure, which increases the chances of accuracy and reduces re-work.