Steps Involved In Dental Insurance Claims Processing

Collecting insurance from providers for patients may seem like something to it, but there is more, leaving dentists under much stress. Verifying patients' insurance, eligibility, and treatment documentation are some of the complex steps of claims processing that sometimes drive dentists crazy. On the other hand, implementing constantly changing dental claim guidelines and insurance companies' requirements during the claim generation and submission isn't more than a challenge for dentists. Hence, Many practices outsource claim processing options or may prefer doing it all in-house. However, understanding the stepwise procedure and complexities associated with clean claim processing is what makes your practice efficient for patient care and ensures timely reimbursements. Review this comprehensive guide that offers you an explanation of every step involved in dental insurance claim processing and how to overcome dental claim processing challenges with best practices.
Furthermore, you may accept MedsDental Billing Companies' efficient dental insurance claim processing and dental billing to get relief from consuming additional expenses and save time dedicated to your patients' dental care. Outsource dental claim processing with us, for we serve you with our years of experience by handling your job efficiently and making you profitable in the dental business.

The Steps And Essentials Of Dental Insurance Claims Processing

Dental insurance claims processing is an essential component of your practice reimbursement and dental revenue organization. Claim processing is strategic and comprehensive documentation of patient care delivery, including details from patient registration to the explanation of benefits (EOB) and payment completion. The critical steps included in the process are:

• The patient is visiting a dental healthcare provider's office and receiving treatment.
• Claim processing staff then submit dental insurance claims to the patient's dental insurance provider to get reimbursed for the services delivered.
• The insurance provider receives the claim and verifies the details, such as the patient's eligibility for coverage, your credentials, and the accuracy of the procedure.
• The insurance provider then reviews the claim to check its coverage under the patient's dental insurance plan.
• In case the claim gets approved, the insurance company offers reimbursement in a particular amount according to the patient's policy's terms and benefits.
• However, your practice is responsible for the claim denial or rejection, and all the dental care costs are up to your patient to pay.

Accuracy and effectiveness must be your top priority during claim generation because the insurance company's sole reaction to a claim is to ensure the details are complete and accurate. Moreover, the claim must include documentation on the necessity of reimbursement, or else; it is highly likely to get claims denied with even a minor error or information gap. Let's have a look at some of the reasons why your claims get denied.

Common Reasons For Dental Insurance Claims Denials

• Incorrect or incomplete patient information
• Errors and mistakes are part of practice in the process of patient data entry, even in digital record-keeping. Make sure you keep focus on documenting the complete details in the claim form, including:
• Date of birth
• Social security number
• Update the patient's last name following the marriage or divorce.
• Listing valid insurance coverage
• Entering correct patient information into your computer
• Correctly coding a patient's dental treatment.
• Accurate documentation of the insurance provider's National Provider Identifier (NPI) information
• Include all required information in the claim form.

Coding Errors

Dental coding is a significant step as it serves the universal language understood by all in dentistry and insurance companies to offer you reimbursement for the services. Be wary of assigning codes to dental procedures, as coding errors are a significant cause of claim denials. For dental practices to assign accurate CDT and ICD-10 codes is the utmost to get claims reimbursed. Some of the common coding errors that may frighten your practice billing and revenue are:

Wrong dental code assignment - Coding dental procedures at times becomes a challenging job for practitioners because of the similarity of codes or familiarity. Make sure your coding staff gets regular training and education on the right dental code assignment and is aware of the latest ICD and CDT Coding guidelines.

Upcoding and Downcoding - Upcoding refers to the dental fraud when the dentists code services are more expensive than the actual procedure performed. Downcoding is another form of fraudulent practice observed in lower dentistry practices used to avoid the complexity of the actual procedure performed. However, both are sufficient reasons for insurance providers to deny claims.

Unbundling - It is the act of billing two or more dental CDT Codes in place of exclusive code. Unbundling indicates many dental practices at times submit many dental claims for one date of services to get extended reimbursement.

Avoiding documenting medical necessity of dental procedure - Insurance companies need the reason or necessity for a certain dental procedure performed. In case your practice fails to document in claim why a certain procedure, equipment or dental treatment was provided, it is highly likely for the payer to offer payments.

Not following coding updates and changes - There are yearly additions, deletions, and revisions in the CDT codes, including the 175 codes that were changed from 2020 to 2024. Ignoring the yearly changes and updates in the dental coding system is another cause for claims to get denied.

Missing Timely Claims Filing

Documenting claims in a timely manner right after the services are rendered is another necessity of clean dental claim processing. In order to provide timely reimbursement, it takes one year for dental insurance to reimburse as per the many dental plans after the service delivery. Some plans also require claims filing within 90 days of the service. Hence, ensuring that the details of each insurance payer are known will help you to file a dental insurance claim on a timely basis. However, if the dentist did not submit a claim timely, they can experience appeals being denied due to late filing.

Steps Involved In The Process: The Way To Faster Dental Insurance Claims Payments

Verify Eligibility Beforehand

Ensure that patient insurance eligibility is verified before proceeding with the treatment. It will help you provide the complete breakups of a patient's plan, including the covered dental procedures benefits, the percentage they are covered, benefits used elsewhere, the limit of the patient plan, and out-of-pocket dues. Furthermore, the procedure ensures claim accuracy, will pay dental clinics for services, avoids reimbursement delays, and prevents claim denials.

Pre-authorization

Pre-authorization or prior authorization does not guarantee payment, but it is the dentist's one of the steps in insurance claim processing that determines patient coverage. Dentists analyze patient coverage by asking insurance companies about the patient's reimbursement and their co-pays. On the other hand, patients get help determining their payment by knowing their co-payments. However, the co-pay refusal can likely lead the practice to get the claim denied.

Accurately Coding Dental Procedures

For your practice to get quick claims recovery and payments, accurate code assignment is key. Properly coding dental procedures will enable you to confirm claim accuracy, guarantee insurance company policy compliance, maintain billing, streamline operations, and also enhance effective communication with dental practice insurance companies.

Get Informed On Coordination Of Benefits (COB)

Insurance companies coordinate benefits in case a patient has more than a single plan to avoid duplication. The patient's primary plan pays the initial costs whereas, the secondary plan is subjected to cover the remaining expenses of dental care on the primary plan's reaching its limits and benefits. Such scenarios make it difficult for dental billers to set patient accounts for both coverage plans. However, your practice must get knowledge on COB rules and get in contact with dental insurance payers to improve the coordination of benefits.

Electronic Claims Submission

Managing and submitting dental claims electronically is one of the effective methods in the digital era. Electronic claim submission eliminates the need for paper-based claims, error-reduction, and accelerated payments for your practices. To make you clear on the benefits of electronic claim submission, here is a comparison:

Electronic Claim Processing VS. Paper Claims Processing

Electronic Claim Processing	Paper claims processing
Reduced errors and data entry mistakes Quick processing times Easy tracking and claim management Lower administrative costs Faster reimbursement for dental care providers	Higher likelihood of errors and data entry mistakes Slower processing times Inconvenient to track and claim management Higher administrative costs Delayed reimbursement for dental care providers

Some of the best practices to get faster claims processing

Double-check patient information on the ADA claim form, including:

• Their name matches their insurance card
• Appropriate patient address
• Accurate date of birth of the patient
• Review the treatment to ensure correct CDT codes are billed
• List the treating doctor and correct credentialing information

Insurance verification - through verifying the patient's insurance card, exact coverage, verification of their annual maximum benefit, and your patient's co-pays.

Check the coverage duality - Dissect whether your patients hold dual coverage such as under a spouse or parent in addition to their own plan, they may have both Medicare and supplemental plans, or a government employee plan. In any case, make sure the faster the coverage verification, the faster claims get paid.

Submit claims with pertinent attachments - as per the requirement of an insurance provider. For instance, some ask for pre-authorization, and others, like HMOs, require referrals for specialty treatments and so on. Ensure that pertinent attachments with claims are submitted quickly to get processed.

Outsourcing Is More Stress-Free - Outsource your practice with expert dental claims processing companies like MedsDental Billing Company, who know how to handle numerous claims simultaneously and with accuracy. It's the ultimate solution to the many hurdles faced in the process of clean claim generation and dental claim submission. Dental claim specialists will offer the satisfaction your practice needs and the reimbursement you desire to improve revenue with their claim processing expertise and years of experience.

Test The Benefits Of Automating Dental Insurance Claims With MedsDental Billing

Automation is the solution for transparent and risk-free claim processing. Avoid putting additional efforts into paper-based claim filing, entering patient information, and verifying coverage. MedsDental Billing Company will automate each and every step of dental insurance claim processing to get you reimbursed properly and reduce the administrative burden with the risk of errors in practice. Furthermore, our technology-oriented approach will let you save your budget and increase your dental practice revenue as automation eases the way to complete a dental claim form for manual submission, practice operations and offers accurate and faster payments, leading your practice to improve cash flow, enhance financial performance, and reduce outstanding accounts receivables.