capline dental services

What Are The Most Common Errors When Submitting Claims?

Avoiding Common Provider Credentialing Mistakes
December 27, 2023
5 Tips On How To Get More Dental Patients
January 3, 2024

Claim submission mistakes significantly impact cash flow. No dental office enjoys dealing with payment delays, unexpected bills, and dissatisfied patients. However, rectifying the claim submission process can help you bid farewell to insurance claims errors.

These errors are common, and their ease of occurrence is a primary reason for concern. As a result, dental professionals often face delayed payments, claim denials, and substantial financial losses. Fortunately, improving the claim process or partnering with a third party like Capline Dental Services can significantly enhance your revenue collection.

The article on the most common errors when submitting claims will help you understand which mistakes to avoid to ensure a higher income stream and insurance collection for your practice.

Outdated Version of the Insurance Claim Form:

Using the latest version of the insurance claim form to include all mandatory information is a step towards seamless claims. It may seem straightforward, but knowing which version of the insurance claim form to file can be confusing. Insurance companies periodically update their claim forms, and using an outdated version can result in denials.

In case of confusion, it’s advisable to call the dental insurance companies for confirmation. Using incorrect forms can lead to payment delays. Outsourcing to Capline Dental Services can assist dental offices in recovering lost revenue. Our experts possess comprehensive knowledge on the subject and can transform your Revenue Cycle Management (RCM).

Coordination of Benefits as a Claim Submission Mistake:

When dealing with multiple insurance plans, patients may be unaware of which is primary or secondary. Many dental professionals struggle with the Coordination of Benefits (COB) and the rules and requirements that dictate the order of filing insurance claims. Keeping up with primary or secondary claims can be tedious. Here at Capline Dental Services, we emphasize the importance of insurance verification to avoid insurance claim errors.

Missing Supporting Documents as a Claim Submission Mistake:

Supporting documents are crucial for submitting clean claims, as they serve as proof of the services rendered. The documents that insurance companies typically require include:

  • Narratives,
  • Clinical notes,
  • X-rays and intraoral photos,
  • Dated periodontal charts,
  • Radiographs,
  • Attachments as per procedure codes,
  • Specialist letters, and
  • Previous treatment history.

These documents demonstrate that the patient received services at the practice, thereby justifying payment from the insurance company for the treatment provided.

Waiting Until the Last Minute is a Claim Submission Mistake:

A common practice is to wait until the last minute rather than submitting a claim within 24-48 hours after its creation. Procrastinating and missing timeframes can increase the turnaround time on insurance claims. Dental claim approvals can take weeks, so it’s crucial for dental offices to submit claims promptly. This not only avoids errors due to claims sitting unsubmitted in the software but also maintains a steady cash flow to keep the practice operational.

Rushing Through Patient Information:

While promptly submitted claims have advantages, they should not contain careless mistakes. Incorrect patient information, such as invalid insurance numbers, misspelled names, wrong birth dates, contact details, and other demographic information, often results in claim rejection.

The best way to avoid claim submission mistakes is to have a dedicated biller working on the claims.

Failure to Check Insurance Coverage:

A common issue arises when the coverage, eligibility, benefits, and preauthorization of patients are not verified at the time of the appointment, leading to claim rejections and payment delays. Although it is time-consuming, thorough scrutiny can help dental offices avoid insurance claim errors.

Wrong Coding:

For CDT codes, it is crucial to stay updated due to the continuous evolution and changes in dental procedures. The code additions, revisions, and other changes are detailed in the current CDT manual compiled by the ADA. Incorrect coding is a common reason for reduced collections. 

To avoid such errors, regularly update staff members with coding guidelines. Utilize a reliable coding resource like Capline Dental Services to avoid claim submission mistakes and secure the cash flow your practice deserves.