Why Are Your Dental Insurance Claims Being Denied? 9 Possible Reasons Why

Why Are Your Dental Insurance Claims Being Denied?🔗

Most dental insurance claims are denied because of small mistakes that are easy to miss.

If your dental insurance claims don’t get paid, your dental practice doesn’t get funded. That’s the math.

So, what are the top reasons why your dental insurance claims are denied? Most claims are denied because of small mistakes that are easy to miss.

Here are five valuable tips you can use to speed up your dental insurance verification process, so you can cut down your patient’s out of pocket expenses and boost your reimbursement from the insurer:🔗

1

You’re using the wrong dental codes.🔗

For a dental insurance claim to be processed properly, you must use the right code to identify your diagnosis, the services you rendered, and the procedures you performed. The code is probably either a CDT code or ICD-10-CM code. It’s easy to use the incorrect code, because codes are being updated every year. That’s why it’s vital to keep up to date with the latest coding changes.

2

You’re using outdated dental insurance claim forms.🔗

Just like codes get outdated, so do dental insurance claim forms. Insurance companies are always updating their claim forms, and the information they’re asking for is constantly changing. Are you using the latest forms? It’s wise to check, so call the insurance company to verify. Otherwise, your claim will bounce.

3

Your dental insurance claim contains incomplete or incorrect information.🔗

Even if you only make a small mistake on a dental insurance claim form, it can be rejected. Did you spell the patient’s name right? Get their insurance number right? It’s also possible the patient updated some of their information but forgot to inform you. That’s why it’s smart to ask your patients at every visit if any of their personal information (such as their name, address, or employer) has changed since their last visit.

4

You didn’t verify their insurance properly.🔗

Dental insurance claims are often rejected because the dentist’s office didn’t perform dental insurance verification properly. In other words, the dentist went ahead and did work that wasn’t covered, assuming that it was. Before a patient walks in for their appointment, check to see if they’re still usingthe sameinsurance or if their benefits or group number has changed.

5

You’re submitting information and files that are unreadable.🔗

Sometimes it’s necessary to submit handwritten dental forms that have been scanned in. The problem is, when the insurance company takes a look at these scanned images, they can’t read the handwriting either because it’s not clear enough, it’s smeared, or it’s illegible.

Another problem can arise when the images and x-rays attached to your dental insurance claim are of poor quality and difficult to interpret. Consider using an intraoral camera, and when you submit x-rays or charts, be certain to send the right version and guarantee they’re mounted, labeled (right/left), and readable.

6

You forgot about the missing tooth clause.🔗

Let’s say a patient visits you with a missing tooth, insisting they have dental insurance, and ask you to fix the missing tooth. After you file your dental insurance claim, the insurance company rejects it because the missing tooth was extracted before the patient’s dental coverage kicked in. As a result, replacing the tooth is not considered a covered benefit. This underscores the importance of thorough dental insurance verification. Know how to what extent your patient is covered before they get in the chair.

7

Your claims are being denied because of contractual clinical denials and contractual limitation denials.🔗

Your claim can be denied on the basis of a contractual clinical denial because some contracts don’t cover certain services, such as cosmetic procedures. You can encounter a contractual limitation denial because the contract limits dental services based on the patient’s age, a waiting period, or frequency rules that govern how long you must wait before you can perform additional procedures on the same tooth. To reiterate: this is why thorough dental insurance verification is so crucial.

8

You didn’t explain the reason for the procedure on the claim form.🔗

Every time you submit a dental insurance claim, you have to explain in detail why a procedure was performed. Otherwise, the claim will be rejected. In fact, some dental offices have gotten into legal trouble for using boilerplate explanations of patient procedures. Insurance companies catch on quickly if you’re using stock language for responses.

9

A patient’s status as a student wasn’t properly verified for their insurance coverage.🔗

If your patient is a student, check beforehand to see if their status as a student is sufficiently documented, since this can result in a denied or delayed claim. Ask the insurance carrier what information you’ll need concerning their status as a student. Here’s another reminder how crucial it is to get dental insurance verification done right.

By the way, maybe there’s another reason why your claims are being delayed or denied: Medusind isn’t your dental billing provider. Medusind is considered a national leader in dental billing (also known as revenue cycle management), and we handle everything from dental insurance verification to leaving no charge behind by chasing down every claim. Contact us and let us show you how we can boost your practice’s profitability with superior claims management.