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  • Sarah Beth Herman

Top 10 Dental Insurance Topics You MUST READ



It's time for us to share with you the most sought after information about Dental Insurance we hear.

  1. Many insurances (Cigna to name one) are changing the rules for preventive procedures. They are no longer being applied to maximums with PPO insurance companies.

  2. Insurance companies are paying claims within 14 days. If you are waiting until day 30 to check the status of claims, you are negatively impacting your revenue cycle.

  3. Wait for Tracer Numbers BEFORE you start posting your EFT payments. The money is not yours until a tracer number is showing int he payment (Specifically your MetLife Payments).

  4. STOP accepting Virtual Credit Cards. If you accept them, you can call the insurance company and request paper checks. You DO NOT have to pay merchant fees on those.

  5. YES, it totally pays off to have a company like this to take care of your dental insurance billing, claims research and authorization submission. (Make sure when you outsource you find a flat rate fee-based company and never go with itemized charges, % of production fees etc).

  6. Always set up your dental claim fee schedule to be the office UCR. Never set this to match the fee schedule of the insurance. (This helps increase your payments when fee schedules increase or patients have zero coverage and you are able to charge for the procedure).

  7. If you are new to billing insurance claims and you do not have a company that does this for your office, always reference the clinical note for your narrative if the dental insurance company is requesting one.

  8. D4346 is one of our favorite recommendations for hygiene billing codes. If you do not use this code, you should be talking to your hygienist about it.

  9. Another tip on codes: D9940 is an OLD CODE, stop billing for this ASAP. New Codes: 9944, 9945, 9946.

  10. Last but NOT LEAST... We beg you pretty please to STOP making up your own percentages for downgrades. When you find out a procedure is downgraded, DO NOT just change the percentage 10%, 12%, 16% or _% less than the standard coverage. This is not an accurate treatment planning.

This is the proper math:

  • Step One: Allowable Fee for the Downgraded Procedure Code x % Coverage for that category = Amount insurance will pay.

  • Step Two: Allowable Fee of the Upgraded Procedure - Amount Insurance will pay = True Patient Copay.

There is more, there is so much more but you get the gist. We LOVE OUR JOB. Like love love love it, and we want your office to know that dental insurance details are important. If you need help, let us know. We would love to join forces and support your dental practice.


All my best,







#dentalinsurance #dentalinsurancecompany #dentalsupport #dentaldowngrade #dentalcrown