Dealing with Denied Dental Insurance Claims​

If you are unable to turn insurance claim denials into payout, you’re not alone in this struggle—and this is where effective denial management strategies make a difference. Recent data suggests that 50% of dental insurance claims for procedures are sent back to the dental office.

But we at Triton Medical Solutions are confident in our ability to submit perfectly clean claims and get them accepted the first time. To avoid recreating claims and conducting follow-ups, our team has rounded up the errors they see most often on denied dental insurance claims.

Incorrect Dental Codes

The dental claim should identify the medical condition, services rendered, and procedures performed with the right code set. However, using an incorrect dental code is easy, as current codes constantly update and change.

For this reason, knowing dental codes should become your team’s ultimate goal, highlighting the importance of accurate CDT coding. Invest in their education on the dental codes to prevent costly mistakes and fraud. Your team should recheck the annual CDT Code book every year to stay ahead of the curve. 

Incomplete or Inaccurate Information on the Dental Insurance Claim

This is one of the biggest causes of dental insurance claims being denied, as even the tiniest mistake is a valid reason for companies to reject the claims.

It’s common to misspell a patient’s surname, add the wrong insurance number, or make any other input mistake. Sometimes, however, it’s not the administrative team’s fault. Perhaps the patient’s information has changed, and they haven’t informed you in time.

Not Verifying Patient Insurance Benefits Before Their Appointment

Your front office must verify the patient’s benefits a few days before their appointment. A lot can change between scheduling a visit and showing up for it – the address, group number, and even the insurance company.  

Check whether a patient’s personal information is current, if their benefits have changed, and how much of the procedure their dental insurance will cover. This ensures that you have accurate insurance information for the patient.

Unreadable Procedure Attachments and Insufficient Documentation

Submitting blurry X-rays and charts for major services like crowns and bridges is the easiest way to get your claim denied.

Ensure you have attached high-quality images and X-rays to your claim, and they accurately convey the condition of the patient’s mouth. This is feasible only if medical professionals use the right intraoral camera and X-ray machines.

Incomplete Narrative on the Claim Form

A dental claim form can’t do without an in-depth explanation tailored to each patient’s unique situation explaining why a procedure was needed.

Instead of using stock, pre-written narratives, do this:

• State the clinical condition of the patient’s oral activity.
• Describe the procedure performed.
• Explain why you needed additional time or materials.
• Explain in what way cutting-edge technology was implemented

Unclear or insufficient documentation and/or radiology views

Submitting incomplete documentation and/or unclear radiology views can cause delays and denials processing claims.  These deficiencies can lead to lower reimbursements or total denial of payments causing your team to write lengthy appeals. You can avoid this by using electronic health record software tailored to your practice.

Electronic health record software provides the ability to document  treatment effectively and streamline your clinical workflow. By researching various software products, you can find one that will fit in your practice and boost profits.  Besides considering price and  clinical templates review the software’s longevity, technical support, updates, and training. Most importantly, is it user friendly? Whether you choose a cloud based platform or an on premise system, the choices for high quality dental billing and clinical documentation software can significantly streamline your business mode.