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3 Reasons Why Dental Claims Are Rejected

3 Reasons Why Dental Claims Are Rejected

How can your dental practice sidestep these common pitfalls?

If you’re a dentist, it’s frustrating to have your dental claim rejected—the funds are due you, what’s the holdup? But if you are expecting those funds, now you’re facing a financial shortfall, and you have to resubmit the claim. How can you avoid these headaches?

Here Are the Three Most Common Reasons Why Dental Claims Are Rejected
1

Incomplete or Incorrect Information

A major reason why claims are rejected are because they contain incomplete or incorrect information. To be processed correctly, your dental claims must feature detailed and accurate information. This includes patient demographic data, provider details, treatment codes, and specific descriptions of the procedures performed.

Common errors are:

  • Missing Information: Your claim will be rejected If you left any required fields blank, such as the patient’s date of birth or the provider’s National Provider Identifier (NPI).
  • Incorrect Codes: Dental procedures are categorized using specific codes known as Current Dental Terminology (CDT) codes. If you use the wrong codes, or if the procedure isn’t covered under the patient’s policy, your claim will be denied.
  • Typos: You claim can be rejected because of simple typographical errors, like misspelling a patient’s name or inputting the wrong insurance ID number.

How can you prevent these errors? Regularly train your staff on the importance of accurate coding and documentation, which will minimize these mistakes. Also, by using dental practice management software, you can streamline the claims process and reduce errors.

2

Lack of Pre-authorization

Many dental insurance insurers require pre-authorization for specific treatments, particularly if they’re considered more extensive or costly. If you as a dentist perform a procedure that requires pre-authorization without obtaining it first, the insurance company will view that as grounds for rejection.

For example, you often need to get pre-authorization for major procedures such as crowns, bridges, and orthodontics. If you don’t get prior approval, the insurance company will deny the claim. In addition, each insurance provider has its own guidelines for pre-authorization. If you don’t follow these protocols, the claim will be denied, especially if you submit the claim before you get the authorization.

The answer? Your practices should check whether you need pre-authorization for specific procedures. If you keep current with your patient’s insurance requirements and get all necessary approvals before treatment, both your patient and your practice will be spared unexpected costs.

3

Non-Covered Services

Many claims are denied because you delivered services that aren’t covered under your patient’s dental insurance plan. Many patients assume that the insurers will cover all treatments they receive—but they don’t realize their insurance policies impose limitations and exclusions.

For instance, many insurers won’t cover cosmetic treatments such as teeth whitening or veneers. If a patient goes ahead and has these procedures done, they might be surprised when their claim is rejected. In addition, you have to consider frequency limitations. Many dental Insurance policies restrict how often you can perform certain procedures. Your patient’s plan might cover only one set of X-rays per year, but if they require additional X-rays within that timeframe, the insurer will reject the claim for the extra set. Another consideration: the insurance company may require additional documentation to prove that a treatment is necessary. Without this evidence, a claim will be rejected.

To avoid this roadblock, your dental offices should supply your patients with a clear overview of their coverage, including potential out-of-pocket costs for services that may not be fully covered. This will help your patients to understand how their dental insurance policy governs what services are covered, with any limitations that may apply. They’ll also avoid surprise bills.

It’s Complicated

Filing dental claims can be complex and frustrating, and when they’re rejected, it can result in financial strain and frustration for both patients and dentists. By understanding the common reasons for claim denials—such as incomplete or incorrect information, lack of pre-authorization, and non-covered services—your office can take proactive steps to ensure smoother claims processing and speedier payment, resulting in more money in the bank for you.

If you’re having problems with claim rejection, Medusind can set your dental practice on the right track to profitability and operational efficiency. As a national leader in dental billing and collections, we are noted for our speedy insurance verification—three hours for same-day appointments, two days for future appointments.

Contact us so we can analyze your unique situation and show you where we can offer financial and logistical support. Our clients enjoy a 12% increase in collections revenue and a 40% reduction in labor costs.



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