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Greetings, fellow tooth enthusiasts! Today, we're going to dive into the thrilling world of dental insurance claims. I know what you're thinking - "Wow, this sounds even more exciting than watching plaque form on my teeth!" But trust me, by the end of this free training, you'll be grinning wider than a mouth full of freshly whitened teeth. So sit back, relax, and let's learn how to make those stubborn claims submit to our every whim (or at least our every request).
Are you a dental employee with the power to file and resolve insurance claims, or perhaps you've been entrusted with
the mission of clearing out your dental office's ancient dental insurance AR (Accounts Receivable, but you knew that already, right?) Either way, you're a vital cog in the toothy machine that keeps patients smiling. But, like any good superhero, you may encounter villains along the way - in this case, the dastardly Denied Claims and their evil henchman, Error. Fear not, intrepid dental employee! With a few simple steps, you can vanquish these foes and restore peace to the insurance realm. Here is what you need to start with:
1. Review the claim in error carefully. Make sure you understand exactly why the claim was denied or what errors were found. The claim response should provide specific details and instructions for how to proceed.
2. Get your Sherlock Holmes hat and magnifying glass ready, because we're going on a documentation scavenger hunt! When an insurance claim gets denied or decides to play hard to get, it's time to gather some supporting evidence. We're talking treatment plans, x-rays, receipts, and anything else that can prove your case. Think of it like being a lawyer for your patient's teeth - but without the fancy suits or dramatic courtroom scenes. So grab your dental detective gear and get ready to solve the case of the missing claim approval! Get everything together you can to prepare to rebuttal the claim: narratives, X-rays, intraoral photos, 3rd party receipts, and prior placement dates and anything else you can get your hands on.
3. Contact the insurance company. If you're unsure about why the claim was denied or what errors were found, reach out to the insurance company for clarification. They should be able to provide more information and help you understand what needs to be done to correct the errors. One of the biggest issues you may face is not understanding why they are asking for documentation again when you already sent it the first time. This is just a transmission error and the insurance company can often help you find a faster way to send what they need.
4. Work with the patient. When you have that code red ..... a patient who has filed an insurance claim and needs our help to bring it back from the brink of denial doom. Don't worry, dental fam - we're on the case! First, you gotta gather all the necessary documentation and lend a hand in completing and resubmitting the claim. And just like a good dental sidekick, we'll double-check everything for accuracy and completeness before we unleash the claim into the wild, wild world of insurance. So put on your trusty cape, grab your patient's hand, and let's save this claim from the abyss! Ok enough jokes... but for real you gotta take a minute to put on the coat of armor to make sure you get the documentation they need to fix everything.
5. Follow up it is necessary. If you don't hear back about the resubmitted claim within a reasonable amount of time, we say within 10 days to follow up with the insurance company to ensure that the claim is being processed. They should pay right away.
6. Claim errors can be as simple as the wrong address, date of birth, or even student status. This is one big reason the focus on making sure you include all details before the initial submission is so vital. Add in all prior placement dates, prior authorization codes, and details you can. This will expedite all claim processing.
By following these steps, you can help your dental office resolve errors on their dental insurance claims. It's important
to be proactive and stay on top of the process to ensure your office is paid for services rendered. Remember, when you fail to plan for insurance to pay on time it really means you are planning to fail on getting the payment. You may hear from other dental professionals to not worry about narratives until the insurance asks for it or you might hear that you don't need to send attachments for certain procedures, send it all anyways. Clear out your AR every 14 days, like a boss!
Dentistry Support ® provides remote support for dental offices nationwide. We serve the needs of any size dental office including those with Spanish-speaking needs on both the east and west coasts of the United States of America. Learn more.
Disclaimer:
To learn more about Sarah Beth Herman, the author of all free training content you can read her bio here. These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based on your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, or insurance carrier). To the extent, Dentistry Support ®has included links to any third-party website (s), Dentistry Support ® intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support ® makes no representations or warranties about the information provided on those sites. You can view our privacy policy and terms and conditions by clicking those pages in the footer of our website.