Everyone makes mistakes now and then, but little things can lead to huge consequences. When it comes to dental insurance claims claims, little details can mean the difference between approved, on-time payment and having to rework and fix them, struggling financially in your practice, or even facing fraud charges. What are common reasons dental insurance claims get denied? Understanding the answers can help you avoid making these mistakes and help you turn your office into a success.
Incorrect Patient Information
With so many variations on spellings and multiple cultures, languages, and accents in the United States, you must make sure you get correct information about the patient, including name, birthday, and policy and group numbers. Sometimes, claims get denied because the patient isn’t even a customer with that insurance company anymore! One errant detail will result in the paperwork being rejected and sent back, wasting your team’s time and resources.
Insufficient Benefits Available
At any point in the year, your patient may have used their dental insurance somewhere else, such as for a dental emergency while traveling or another similar situation. Or perhaps they are a new patient to you, but they’ve seen another dentist this year. Checking their available coverage can help you file claims accurately and not have to follow up with the patient later for additional payment from them.
Wrong Service Code
All services have unique codes, and they can change over time and as technology continues to improve. Before sending your patient’s claim in, make sure the coding is accurate and you have all essential documentation for the work done. After all, you don’t want to be accused of fraud by asking to be paid for the wrong services! If you need to attach clinical notes, photos, or other information, be sure to include every bit the dental insurance company requires. That way, they will have no choice but to approve payment.
Solution: Insurance Verification
It’s impractical to expect perfection from humans; however, you can put processes in place to catch innocent human errors. This system is called insurance verification, and it involves reaching out to the insurance company before the patient’s appointment armed with their information. You can confirm their policy, double check the details of their file, and have a clear idea of available coverage. When it comes time to file the claims, you know you shouldn’t deal with avoidable mistakes.
When you avoid denied claims, your team’s time is used more efficiently, you receive payment you’re owed, and you can build trust with your patients by being accurate and honest about pricing. This extra effort in verification is certainly worthwhile to get approved claims every time.
About Dental Support Specialties
Dental Support Specialties is a remote administrative company that services dental practices throughout the United States. As an extension of in-office staff, we can take care of insurance verification, submitting and following up on claims, and other tasks like answering phone calls. HIPAA compliant and professional, our team members have years of experience working with insurance companies and know what needs to be done to obtain legal approval. Are you interested in learning more about us? Reach out to us to schedule a consultation today!