12 Tips for Successful Dental Claim Submission
- Updated:
- September 2023
- Author:
- Tiffany Wesley, FAADOM
- Topic:
- 3Submitting a Claim
Regardless of dental insurance network status, dental claim submission is a vital process for dental practices, ensuring that they receive reimbursement for the services they provide to patients. However, navigating the complexities of dental insurance claims can be challenging. In this blog, we'll explore 12 valuable tips and strategies to help you streamline your dental claim submission process, maximize reimbursement, and minimize potential denials, delays, and rejections.
1. Insurance administration
Understanding the various dental insurance plans your practice accepts is fundamental. Each insurance payor has its own specific requirements, policies, and guidelines for reporting different dental procedures. Stay updated on the plans you work with, including general insurance administration best practices, to avoid unnecessary dental claim denials, delays, or rejections.
2. Accurate information
One of the primary causes of dental claim denials is incorrect information on the dental claim form. Establish processes in your practice to help you remember to:
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Verify patient information matches what the insurance company has on file
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Make sure payor information is accurate
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Make sure all required boxes are completed on the claim form
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Make sure you’re using the most current ADA dental claim form
Regularly verify and update this information, as the patient is seen in the practice, to prevent delays in revenue.
3. Electronic dental claim submission
Did you know that 80% of the 73 million dental claims submitted in 2022 were electronic? Electronic claim submission is preferred among most payors and can result in faster adjudication. Paper claim submission is much harder to track, but also means unnecessary delays in revenue:
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60% of payors take anywhere from 1-5 days longer to process paper claims
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27% of payors take 6-10 days longer
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1% of payors take 11-20 days longer
Before you attempt to send electronic dental claims, make sure that your practice management software (PMS) is compatible. You will also need to confirm the electronic payor ID is accurate before submitting.
4. Clear and detailed documentation
Thorough documentation is necessary for successful dental claim submission and processing. Your clinical notes and treatment records should include details about the diagnosis, treatment provided, dates of service, and any supporting documentation such as radiographs or intra-oral photographs. Clear and comprehensive documentation can help validate the necessity of the procedures and improve your chances of maximum reimbursement.
Many dental claim submissions require, or would benefit from, a narrative. A narrative is a written explanation of what was done, how it was done, and most importantly, why it was necessary. Here are some important narrative guidelines:
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Be precise
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Avoid handwritten narratives
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Omit irrelevant comments
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Make it patient-specific
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80 character limitation
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Correct spelling, punctuation, grammar
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Must match what is written in the provider’s clinical notes
Another important tip is to never use aggressive language. This includes statements such as “Insurance Commissioner will be contacted if claim is not paid or denied in 30 days.” These types of statements will have no positive effect on the processing speed or outcome of the dental claim.
5. Accurate dental coding
Accurate dental coding is the backbone of successful dental claim submission. It is crucial to stay up-to-date with the Current Dental Terminology (CDT) codes, which are used to report dental procedures. Always use the correct dental codes for each treatment, and make sure they align with the patient's treatment. With over 700 CDT codes and yearly updates, your practice needs the most up-to-date dental coding resources to stay compliant and profitable.
The following dental codes are noted by many payors as having a higher potential for abuse and are, therefore, more closely scrutinized.
Keep in mind that third-party payors closely monitor dental claims data for all procedures, not only those listed above.
6. Insurance verification
Before providing treatment, verify the patient's insurance eligibility and coverage for specific procedures. This can prevent patient balance misunderstandings and disputes later on, as well as denied dental claims. It is crucial to know when to verify and how cementing this processes into your dental practice day-to-day can build trust with patients. Revisit tip #2 for why this information needs to be verified regularly.
7. Timely dental claim submission
Timely dental claim submission is crucial to keep dental practice revenue consistent. Different insurance payors have varying deadlines for claim submission, so it's important to be aware of and adhere to these deadlines. Establish an efficient workflow within your dental practice to submit dental claims promptly after providing treatment – ideally within 48 hours of completing treatment.
8. Outstanding dental claim follow-up
Keep track of your submitted dental claims and their status so that you don’t lose revenue that is rightfully due to your practice. Follow up on dental claims that are pending for an extended period at least every 14 days. If the claim is denied, and you aren’t sure why or you disagree, contact the insurance company immediately. Pro tip: If you are using tip #3, check for rejected claims weekly.
9. Appeal denied dental claims
Claim denials are not uncommon, and they don't necessarily mean the end of the road. Many denials can be successfully appealed with proper documentation and communication. Did you know that only 33% of denied claims are appealed? Establish an internal process for identifying if the dental claim can be appealed, then successfully appealing so that your practice receives the reimbursement it deserves.
10. Team education
Effective dental claim submission is a team effort. Encourage your staff, including front desk personnel and dental assistants, to stay up-to-date on dental claim submission, dental coding, and insurance verification. Regular training and updates can help your team stay informed when it comes to dental industry changes and best practices.
11. Consider outsourcing
If managing dental claims becomes – or currently is – overwhelming, consider outsourcing your dental billing and claim submission to a professional dental billing platform. These dental billing specialists handle dental claim submission and follow up, reducing the administrative burden on your practice, and improving efficiency.
12. Monitor & analyze trends
Keep a close eye on your practice's dental claim submission and reimbursement trends. Analyze data to identify recurring issues, such as frequent denials or delayed payments. This proactive approach allows you to pinpoint areas for improvement and make necessary adjustments to optimize the process.
Successful dental claim submission is essential for maintaining a healthy revenue cycle in your dental practice. By following these twelve tips, you can enhance your dental claim submission process, minimize delays, and maximize reimbursement.
