Top 5 reasons for dental claims denied

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Top 5 reasons for dental claims denied

Dentistry is simply dealing with what the insurers want from you, what your front office can deliver, and the patient’s expectations. It can be a struggle to a point when you do everything, and the claims get denied entirely. Without knowing the process, you are out of cash in your dental practice. Dental providers serve patients exceptionally, and therefore getting paid is equally crucial. 

Before moving further, your dental practice should know that there is a slight difference between claim rejection & claim denial, although both mean no reimbursement.  

Let’s look at the top five reasons dental claims get denied and how your practice can resolve them for reliable and consistent cash flow. 

Inaccurate Patient information on the dental claim insurance: Claim denials are often due to incorrect patient information. It seems like a no-brainer, but one of the common reasons for prolonging the revenue cycle. It is easy to misspell the patient’s name, input the wrong insurance number, transpose digits in the ID number, etc.

Another reason for input error could be that your patient updated some of their information, like employer, name, and address, without informing you. Always confirm the details since their last visit.

Filing an insurance claim after the deadlines: Different insurers have different deadlines for insurance claims, and keeping track of individual carriers is tough. Although, their window has around 60-90 days to file a claim. It starts on the service day. It is best to submit claims as soon as possible to avoid the pile. 

It is best to call the insurer company and clear things up to fill out the paperwork and keep a balance between the dental practice and the administrative tasks. To resolve this issue, outsource the dental claim service and get professional assistance from trained billers that help you by taking your claims, coding, billing, and timely filing.

No pre-authorization: Providers know that neglecting pre-authorization can cause the practice and patient money, unexpectedly leading to dissatisfaction. It is one of the top reasons claims get denied, and often providers tend to miss due to the workload given for a certain amount of time. 

There are certain appointments, some days before pre-authorization runs out. 

Not to overlook, as it is the only way to ensure reimbursement and get paid for the rendered service. 

Not reviewing the patient’s coverage: Sometimes, the provider fails to cross the insurance plan benefits. If a patient comes into your office claiming that they have dental insurance. It is still a good practice to ask your staff to have a run-down of the coverage before the insurance company denies the claim stating it is not a covered benefit. 

Unnecessary denials affect your organization’s revenue cycle because the insurer will not pay for the non-covered treatment, and your patient will be surprised by the bill. To avoid this confusion, review the patient’s file before they enter the office for updated information and active dental benefits.

Ignoring the Insurance Verification process: Performing accurate insurance verification is an indirect revenue generator. Sometimes the provider goes for the treatment without double-checking the patient’s claim. The insurance companies deny the claim due to the non-verification. 

That can be a loss in revenue which any dental practice does not want again and again. Moreover, verification helps in preventing denials and fraud.

Insurance verification ensures that the submitted claim is correct. The submitted documents are cross-checked, thereby eliminating the chance of denial. Therefore, providers must not ignore this process.

Nobody likes to work on denied claims as it increases time and energy. Communication with the patients and the insurers, well-trained staff, professional coders & billers can substantially minimize the risk of claim denial and the headache that goes hand-in-hand with the claim.