capline dental services

Top 5 reasons why Dental Claims are denied

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According to the recent survey conducted by the American Dental Association, approx. 65% of patients rely on insurance to help them pay for the treatment they want. However, there are times when a claim gets denied or delayed for a variety of reasons. Claim denials can hurt both Dental Insurance Billing Company and patients. Every once in a while when a claim gets denied, it leaves patients with huge dental bills.

To prevent such scenarios in the future, let’s understand the top reasons for claim denial.

Common Causes for Claim Denial

The Treatment Procedure Is Uncovered
When patients opt for dental care, the first thing they worry about is whether their dental insurance will cover it or not. So, whenever the patient opts for treatment that wasn’t covered by the insurance policy, there are increased chances of a claim getting denied.

Error in Entering Patient’s Information
Sometimes a claim gets denied because of simple errors like a misspelled name, policy number and so on. Our experts go through the information carefully and correct any kind of errors before processing a claim. If there was an error on the part of the provider, we ask them to correct it.

Claim Denied for No Pre Authorization
It is seen that 80% of claims get denied with no authorization being obtained. There are some dental treatments that may require prior authorization. It is quite obvious for payers to get prior authorization for complex dental treatments like surgeries. As a part of our eligibility verification process, we work closely to mitigate denials from having an incorrect code on prior authorization.

Claim Denied Due to Issues in COB
COB or Coordination of Benefits is a term used when patients have two or more health insurance plans. There are certain rules that decide which dental insurance plan pays primary, secondary or tertiary. Providers need to ask patients whether they have primary, secondary or any other carrier. Once the information is acquired, we can easily use it while billing the insurance carrier. This ultimately reduces the number of delays or denials.

Claim Not Filed on Time
One of the major issues practices encounter is when claims are denied for timely filing. Since each carrier has its own set of guidelines and policies, it becomes important to stick to them. Claims are often denied for timely filing when the claim was submitted on time but not received by the insurance carrier.

To prevent such issues, it becomes mandatory to file claims within the time period.

By implementing these tips, you will be able to optimize claim processing for your practice.