What’s a claim?
When you, as a dental service provider, submit a formal payment request to a dental insurance company for the services rendered, it is called a claim. Then, the dental insurance company examines the claim where its accuracy is verified, and based on the details submitted; it’s either approved or denied.
What happens if a claim is approved or denied?
If a claim is approved, the dental insurance company pays you for the services you provide to your patients. But what happens if a claim is denied? If a claim is denied, it simply means that the insurance company has rejected or denied the claim and will either pay partially or not pay at all the amount you requested for.
Let’s look at some common claim denial reasons first to understand why claims are denied in the first place.
Common reasons for claim denial
So, if your claim has been denied due to one of the reasons mentioned or any other valid reason, you need to analyze the claim denial reason first, which is mentioned in the Explanation of Benefit (EOB) letter received from the insurance company.
The EOB letter mentions the reason for settling or rejecting a claim. Post analyzing the claim denial reason; you can resubmit the claim after making the required corrections as per the insurance company’s guidelines.
But, if your claim is denied for an incorrect reason, you can raise an appeal against it. To fight a dental claim denial, you should know the appeal process. Let’s first understand what an appeal is.
What’s an appeal in case of dental claims denial?
It’s a formal request to an insurance company to reconsider and reprocess the denied claim. As a dental professional, you can raise an appeal if either a claim is denied or you received less than the required amount.
Make sure that you have all the supporting documents and a solid argument to succeed. So, analyzing dental insurance coverage is the first thing before processing an appeal.
Things to consider while raising an appeal:
As a dental professional, you must be extremely careful in providing correct information, supporting documents, bill details, etc., while submitting a claim to avoid claim delay or denial. An in-house billing team is suitable for all your billing and claim-related issues but outsourcing the dental billing services to a reliable partner is even better.
It’ll save you time, effort, and money, reduce claim denials, and eventually boost the revenue for your practice.