Top 5 reasons for claims denial and delay in Dental Billing

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Timely claim submission and approval is one of the top priorities of healthcare professionals involved in dental practices. What makes it a top priority for dental practitioners is its contribution to revenue generation. 

As the world is living under COVID-19 scare and industries across the globe are working towards repairing the fallen economy, dental practitioners also need to make sure that their revenue cycle keeps moving smoothly. 

Claim Submission plays a pivotal role in maintaining and improving revenue cycle outcomes, but the process of claim submission and approval is not as easy as it sounds. Even a slightest mistake in the patient’s details or dental codes can result in claim denial or delay. 

To keep the revenue running, dental professionals need to focus on the reasons that can cause claim denial or delay in the claim approval process. 

This article will talk about the 5 of such most important reasons for claims denial and delay, and the measures to be taken by the dental practitioners to avoid them. 

  1. Incorrect or wrong information – While sending a claim for approval, it is vital for intake staff to verify all the details of a patient. Sending wrong information in such cases becomes the first reason behind the claim denial. During registration of a patient, make sure that all the details are cross-checked. Creating a list of common mistakes, especially while doing insurance verification, such as generally misspelled names, commonly missed fields in the form, etc. It might consume a bit more time but it will definitely reduce all the chances of claims denial. 
  2. Incorrect or missing Billing Codes – Specifications are important when it comes to billing codes. Invalid, incomplete, or erroneous codes will directly result in claim denial. Billing staff or coding specialists should be extremely careful while entering codes. Even the slightest mistake in medical codes can postpone or deny claim approval. 
  3. Unauthorized claims – There are many dental services that require pre-authorization. Insurance providers are likely to decline or deny any claim sent to them without proper or prior authorization. Categorize these dental services in advance and submit the claims accordingly. 
  4. Late submission – The term is self-explanatory. Any claim, if submitted late, will obviously be denied even if it has all the correct details and medical codes. For timely claim submission, keeping a track of each patient’s deadlines is important. Make sure not to miss them to avoid any reason that can cause claim delay or denial.  
  5. Credentialing – It’s a crucial factor. Dental practitioners need to be credentialed with insurance providers. And if they are not, getting claim approvals does not come easy. It’s essential for dental practitioners to be credentialed with the insurance providers, not just one but with other insurance providers as well. 

Apart from these reasons, there are some other common reasons as well for claim denial and delay. Let’s take a look at them.

  • A claim submitted with expired health insurance will automatically be denied. Make sure to check the validity of the insurance before submitting a claim. 
  • Some insurance companies have the policy to provide only one service in a day. If the claim is submitted for two or more services and the provider complies with this policy, the claim is likely to be denied.