There are many reasons why dental insurance claims may be denied. Some claims tend to be more frequently denied than others. More information may be requested to decide whether the claim will be accepted or denied especially in surgical procedures.
Whatever the reason may be, when a claim is denied, it can be very frustrating for all parties involved. Your patient may not be able to get the care they need. Or, they may end up with a much higher cost for a procedure. And your practice may end up with a longer wait time to be reimbursed for your service as well. That is why it’s important to understand why claims get denied. When you do, your dental practice can provide patients with the best possible care.
Using an Incorrect Dental Code
The American Dental Association (ADA) recognized a need in the dental community to educate dentists and dental staff on how to respond to claim rejections. One of the multiple possibilities the ADA lists as a reason for a denied claim is improper coding. Dental insurance claims need to be coded correctly when they are submitted to insurance in order for the claim to be processed successfully. That means that an incorrect code can have a big impact on whether a claim is successful or not.
Be careful that the diagnosis, service and procedure listed match the most current code. The code may be a CDT code or an ICD-10-CM code. They may change as frequently as every year, so it can be difficult to remember each and every change. That makes this one of the top reasons for a claim denial. Prioritize learning these codes to avoid making mistakes that may be costly.
Having Incorrect Patient Information
Technology is used in so many ways that make our world an easier and more convenient place. That includes the use of technology to file and review insurance claims. Unfortunately, a claim may be denied very quickly for something as simple as misinformation. It’s difficult for a software to recognize mismatched information, even if it’s as simple as a single letter difference in a name or an incorrect number in a birth date. When entering insurance IDs, names, dates and other identifying information, make sure you’re entering information with care and double check that no corrections need to be made before you submit the final claim.
Unverified Patient Benefits
Another potential reason for a claim denial is because the patient’s insurance doesn’t get verified before a procedure or treatment. To make things easier for your practice, it’s a good idea for a receptionist or member of your dental office staff to ask about insurance coverage before a patient even enters the office. This ensures that the patient does actually have insurance to process, that their benefits are active and that you are getting the most up-to-date information as possible, so claims don’t get denied for incorrect or out of date information.
Even if a patient has the same insurance company, the benefits or group number could have changed. This also provides an extra service for your patient. When a procedure is checked against insurance benefits, your patients also get the comfort of knowing what they can expect. Patients may be more at ease when they are aware of what costs to them may be and whether insurance will cover a specific procedure or not. This saves your practice time and money while also bringing some comfort to your patient.
Timeliness of the Claim
There are so many possibilities for insurance coverage, it’s hard to even name them all. Even if your dental practice only accepts a select few insurance coverages, that doesn’t mean it’s any easier to remember each company’s deadline for filing a claim. Claims that are filed outside of an insurance company’s specified time frame will be denied. Some insurance companies may have a time limit of a year while others may allow 180 days. It may even be a time span as short as 90 days. To avoid a claim being denied and to ensure that you or your dental staff have the easiest job possible, make your best effort to file a claim as soon as a service or treatment has been completed.
If your dental practice is struggling with getting dental insurance claims approved by insurance companies, review these items. You may find that some of these simple solutions like double checking for human error with patient information, educating yourself on dental codes, verifying insurance benefits and entering claims in a timely manner may save you and your office staff from extra work.
If you’re looking to make your dental practice the most effective it can be, contact PPO Negotiation Solutions for more assistance with money and time-saving claim filing expertise.