There is a lot of importance placed on sending a clean dental claim, and rightfully so. A clean dental claim helps increase the odds of timely reimbursement from insurance payors, keeping dental practice revenue more consistent from month to month throughout the year. While sending a clean claim is undoubtedly the best practice to avoid delayed revenue, it isn’t guaranteed to produce the desired result. With insurance requirements changing regularly, it begs the question: Can a clean dental claim be denied? Let’s take a deeper dive into this, with tips and resources from Dr. Charles Blair’s Practice Booster Advisory Board.
Practice Booster tips for sending a clean dental claim
Let’s start with what makes a dental claim “clean.” To start, a clean dental claim is free of errors and utilizes the correct claim form. Here are a few of the key pieces of information needed to properly send a dental claim:
- Complete and accurate patient & subscriber information
- Complete and accurate insurance plan information
- Current procedure and diagnosis codes
- Necessary attachments needed for the procedures included on the dental claim
To avoid dental claim denials and delays due to inaccurate patient, subscriber, or insurance plan information, we strongly recommend that you complete an insurance verification prior to the patient’s scheduled appointment. It can build trust with patients, team members, and dentists. Click below to read more.
Practice Booster tips for timely submission
It will not benefit you to have a clean dental claim compiled and ready to go, only for it to sit in your batch for weeks or months. Claims must be submitted on a timely basis – usually 6 to 12 months after the service is complete – even for non-covered services. Claims submitted beyond the timely filing period will not be considered for reimbursement, which means that holding on to claims could result in uncollectible revenue.
Practice Booster tips for dental claim attachments
The documentation necessary to attach to a dental claim will be treatment and insurance specific. Insurance payors have specific documentation they want to be submitted with a dental claim in order to review for adjudication. Examples of documentation needed for dental claims includes, but are not limited to:
- Radiographs
- Photographs
- Clinical notes
- Periodontal charting
Beyond dental claim submission, dental documentation is the cornerstone for keeping you in compliance and maximizing legitimate reimbursement. Clear, clean, and detailed patient records are crucial to meeting regulatory requirements and providing a comprehensive picture of the patient’s dental history and treatment.
Join us as we delve into the world of dental documentation and uncover the secrets to creating comprehensive and compliant patient records in Dental Zing’s newest dental CE course, Mastering Dental Documentation. Registration includes a complimentary copy of Dental Documentation with Confidence, Practice Booster’s newest resource for maximizing reimbursement and minimizing risk.
Guidelines for successful dental claim narratives
Here are a few guidelines for successful narratives, from Dental Administration with Confidence 2023 Edition:
- It is best to omit irrelevant or unnecessary comments such as “Please process for payment”
- Utilize proper spelling, punctuation, and grammar
- Avoid acronyms
- Never use aggressive or threatening language
Many of the country’s largest insurance payors are embracing evidence-based reimbursements, which means that some payors no longer accept narratives and now require chart notes instead. This is just another reason to make sure your clinical chart notes and documentation are accurate, concise, and thorough.
Practice Booster tips for clean dental claim denials
Even a squeaky-clean claim can be denied. Sometimes a procedure is denied due to a missing tooth or a non-covered procedure clause, but an alternate benefit may be available. The key is to appeal and ask if there is an alternate benefit available. The insurance plan document may also outline the alternate benefit provisions of the plan.
Sometimes a clean dental claim will be denied due to needing additional information, or because the claims adjuster didn’t see the reasoning for the treatment based on the documentation provided. Surprisingly, only about 33% of denied claims are appealed. One reason for this low statistic may be a lack of knowledge surrounding the appeal process.
Prior to sending any appeal, it is crucial to read the EOB carefully and be certain you understand the language of the explanation provided. If you are unsure of what information the insurance payor is requesting, call to confirm exactly what is needed to continue the review of the claim. Do not hesitate to speak with a supervisor for clarification.
About the Practice Booster Advisor
Dr. Greg Grobmyer is a Practice Booster Senior Advisor, Editor-in-Chief of Dental Coding with Confidence and the Insurance Solutions Newsletter, a Dental Zing course creator and lecturer, contributing editor to the Dental Administration with Confidence, Dental Technology with Confidence, and Dental Documentation with Confidence books, and host of The Dental Code Advisor podcast.
