Dental organizations strive to provide top-notch patient care, and ensuring that their medical filing process is efficient and effective is crucial. Dental accidents can happen anytime, and proper medical filing for it is crucial for receiving the compensation that dental practitioners deserve. However, dealing with medical bills and insurance claims can be overwhelming, especially when dealing with accidental dental claims. It is the responsibility of the individuals involved in performing this task to lead this process carefully and professionally for timely reimbursement. To do so, it is essential to have a solid understanding of medical filing tips for dental accident claims. By implementing these tips, dental organizations can streamline their filing process, reduce errors, and ensure they are appropriately reimbursed for their services. In this article, we will explore some user-attractive and unique tips to help dental organizations improve their medical filing process for dental accident claims.
Medical filing tips for dental accident claims
An accidental dental claim is not treated the same as a regular one because accidental dental benefits are processed under EHB instead of EOB. With the right filing tips, you can streamline the process and alleviate the stress associated with dental accident claim filing.
Check coverage limitations
The first step in filing a claim for dental accidents is to determine if the insurance policy covers the accident.
- Most dental insurance policies cover accidents caused by a sudden and unexpected event, such as a fall or a car accident.
- However, they may not cover accidents caused by negligence, such as not wearing a mouthguard during sports.
- Some medical insurance plans cover the treatment for the first 24 hours after a dental accident, while others demand that patients get treatment within 72 hours.
- Some demand that they must be informed/notified about the accident within 72 hours to get covered for services.
Understanding what is covered by patients’ dental insurance policies before filing a claim is essential. Checking coverage limitations can help avoid unexpected expenses and frustration when a claim is denied.
Tips to check coverage limitations
Here are some tips for checking coverage limitations when filing a dental accident claim:
Read the policy carefully: Before filing a claim, it is essential to read your patients’ dental insurance policy carefully. The policy will outline what is covered and what is not covered. Pay close attention to any limitations or exclusions.
Check for pre-existing conditions: Dental insurance policies often have a waiting period for pre-existing conditions. If a pre-existing condition caused the accident, it might not be covered.
Verify the deductible: Most dental insurance policies have a deductible. The deductible is the amount patient must pay out of pocket before the insurance company will cover any expenses. Verify the deductible before filing a claim.
Understand the annual maximum: Dental insurance policies often have a yearly maximum. The annual maximum is the maximum amount the insurance company will pay for dental expenses annually. If the accident cost exceeds the yearly maximum, the patient will be responsible for the remaining expenses.
Know payer rules, criteria, and terminologies
It is essential to understand payer policies, requirements, and terminologies to file appropriate claims for dental services associated with trauma. Although many payers’ policy says that dental accident to a sound tooth will be covered, the definition of “sound tooth” varies for different payers. Therefore, it is better to understand the definition and rules of insurers.
One of the most important tips for filing a successful dental accident claim is to request authorization from your insurance provider.
To request authorization;
- You will need to inform the insurance provider about the patient’s dental injury, including how it happened, when it occurred, the type of accident, what kind of treatment you will provide to the patient, and the cost of treatment.
- Moreover, you must provide the patient’s name and date of birth, the subscriber’s name and date of birth, and the medical ID number.
In case when the patient is referred, the dentists should not assume that prior authorization will automatically extend
Know the codes
Fulfilling a claim with the appropriate ICD codes is essential to ensure that the dentist receives proper reimbursement for their medical services.
The coding process becomes even more critical regarding dental accidents, such as a chipped tooth or a broken crown. In such cases, the codes used must accurately represent the dental procedure or service provided to the patient, as well as the severity of the accident.
If a patient chips their front tooth and requires a crown, the following codes may be used:
- ICD code: S02.5XXA – Fracture of tooth (traumatic) – initial encounter
- CPT code: 2740 – Crown – porcelain/ceramic substrate
- CDT code: D2952 – Crown – porcelain fused to high noble metal
Some other codes to report dental X-rays for dental accident claims may include:
- 70328: Radiologic examination, TMJ
- 70310: Radiologic examination, less than complete/full mouth
- 70320: Radiologic examination, full mouth
It is important to note that these are a few codes; a list of all codes can be with dentists or billing specialists.
Completing the medical claim form
- The medical claim form will typically require the dentist to provide detailed information about the services provided, including the diagnosis and treatment provided and the cost of the services.
- The form may also require the dentist to provide additional documentation, such as X-rays or medical records, to support the claim.
- CMS 1500 claim form has some areas, such as boxes ten and 14, to be filled to give proper information. Moreover, if you have extra information to share, you can use box 19 in ICD-9.
The specific information required on a medical claim form can vary depending on the insurance provider, but some everyday items include the following:
- Patient Information: This includes the patient’s name, date of birth, insurance ID number, address, and other personal details.
- Provider Information: It includes the name and contact information of the dental practice or dentist who provided the services.
- Diagnosis Codes: These are standardized codes that describe the specific dental condition or injury that was treated.
- Procedure Codes: These are standardized codes that describe the specific dental services that were provided, such as fillings, extractions, or X-rays.
- Dates of Service: This includes the dates on which the dental services were provided.
- Cost Information: This includes the total cost of the dental services provided.
- Supporting Documentation: Additional documentation, such as x-rays, may be required depending on the insurance provider.
Hire MedsDental Billing Company to file dental accident claims
Are you tired of struggling with the complex process of filing dental accident claims? Look no further than MedsDental billing company for dental accident claims. We understand the challenges of filing dental accident claims and are committed to helping our clients efficiently navigate the process.
With our expert team of billing specialists, cutting-edge technology, and HIPAA-compliant services, we ensure the timely and accurate filing of your claims, maximizing your reimbursement and minimizing your stress. Our unparalleled attention to detail and commitment to customer satisfaction set us apart from the competition. Our team is uniquely equipped to help you optimize your claims and maximize your reimbursements. Don’t let the complexities of dental billing hold you back – trust MedsDental to handle it all for you.