06 Dec Office Managers Can Use Help Getting Claims Paid
By Belle DuCharme, Director of CE/Training
At eAssist we find that often “it takes a village” to get the claim paid correctly the first time. On our team we have ex dental insurance claims representatives, registered and certified dental assistants and registered dental hygienists along with professional dental office managers and insurance coordinators who weigh in on the best way to get the claims paid with the supporting evidence while working with the dental offices to create superior clinical notes with SOAP format and narratives.
We don’t have DDS or DMD at the end of our names so even though we can look at an x-ray and see clinical evidence, we really can’t give a diagnosis. That’s why it is extremely important that we get a narrative or good chart notes from the provider. Each case is different, we use strictly what the office states on a narrative or clinical notes for each claim so we don’t get into a sticky situation in case the insurance does an audit.
During dental examinations it is important that dental assistants and business staff listen and understand what the dentist is telling the patient and in turn this will be recorded on the insurance claim. Insurance companies pay claims based on documented details of what the tooth needs to be restored and why it needs to be restored. Clinical notes supporting the codes on the claim are vital to payment. The dental assistant should be recording these notes in real time in the system so that when the claim is created later it can be used as the narrative. Intra-oral photos have been shown to be of great value in getting claims paid when radiographs do not pick up certain symptoms of the teeth and the gum tissue. Intra-oral photos are great for supporting narratives on claims that are not supported by radiographs.
With our “village” of claims processors we can get claims paid the first time by making sure we have what we need to support the procedures that have been completed.
eAssist Helpful News and Billing Tips; Edition #106