The answer looks like Yes! Dental billing is often complex process for most of the healthcare professionals and revenue cycle management companies. Even a slightest error can cause huge loss of revenue. Revenue cycle management companies manage dental billing process in a way to reduce the stress of healthcare professionals.

It’s also very essential and crucial for healthcare professionals to know the top reasons for dental denials and dental delays. However insurance companies concentrate only on reaping money. They target on monthly premiums and profit gain and avoid claims with reference to documentation in patient’s contract.

Ways to reduce Dental Denials:

  • Do not submit incorrect information and documentation
  • Submit claims within the time scheduled
  • Don’t forget to attach X-rays and claims
  • Attach the description provided by healthcare professionals for X-rays.
  • Keep an eye on frequencies, exclusions as well as limitations.
  • Do not miss on forming an office policy for feasible process.

Common reasons for Dental Denials by Insurance companies:

  • Incomplete information and documentation
  • Late claim submission
  • Missing X-rays and Claims
  • Missing X-rays description
  • Frequencies, Exclusions and Limitations
  1. Incomplete Information and Documentation:

  • Improper documentation and incomplete and inaccurate information has led to 50% of dental denials which has to return to revenue cycle management companies or healthcare professionals with a pending status and no revenue payments.
  • Insufficient information is another most common reason for dental denials. Insurance companies expect for complete patient information without any errors. Incomplete information will not provide the details of the claim they are looking for. Eventually, claims can’t be processed.
  • Detailed information regarding patient information and dental procedures including their ID number, service date should be definitely submitted in the claim form. This information will help to process the claim further.
  • Healthcare professionals’ details are also important while claim submission. Revenue cycle management companies usually collect the details of patient as well as healthcare providers and procedure details that insurance companies are waiting for.
  • Healthcare provider’s name, license number, address and tax identification number TIN, EIN or SSN of dentist is very essential for claim submission process. Revenue cycle management companies should make sure of not missing any of this information during claim submission.
  • Insurance companies will require specific documentation for particular claims to process further. For instance, in the cases of scaling and root planning, insurance companies would require X-rays and prior charting that shows bone loss.
  • A recent study has also revealed either periodontal charting or last six months full mouth series for periodontal, endodontic and also orthodontic procedures are very primary and compulsory for few plans.
  • Information on treatment and procedures and various steps taken for treatment can also prevent dental denials as mentioned in many cases.
  • A well-equipped revenue cycle management company usually has a conversation with insurance companies regarding plans and required documentation for the procedure which indeed keeps dental denials away.
  1. Late Submission:

  • Deadlines are very critical. In fact very important in claim filing process. Missing a deadline can leave healthcare providers under revenue loss. So, it’s essential to train the team to meet deadlines accordingly.
  • Reminders and alerts at front office will aid in following the deadlines and avoiding the mistake. Reminders for individual insurance companies should be documented and posted throughout the dental practice.
  • When it comes to revenue cycle management companies, they have a team to serve healthcare providers as partners and stay in charge of meeting deadlines and submitting claims on time.
  • Claims must be submitted as soon as dental services are availed by the patient. Otherwise there’s a place for dental denials showing the reason late submission.
  • No matter what, the claims should be submitted or filed within one year from the date of service rendered. For other plans, there’s shorter time filing period of 90 days.
  1. Missing X-rays and Claims:

  • Missing X-rays and claims are one of the major concerns as per American Dental Association.
  • Dental providers often submit X-rays and claims before the acknowledge receipt from the insurance companies. As these X-rays and claims are sent several times, there’s a chance for thinking that claims are submitted along with X-rays and dentist will receive EOB for the same.
  • According to Dental Association, each healthcare professional must contact insurance companies personally and individually in order to particularly meet claim processing requirements.
  • Very low standardization of attached documents and inability to reference attached documentation for several insurance payers in a unified location creates major confusion and stands as a reason for dental claim denials.
  1. Missing X-rays description:

  • Revenue cycle management companies or healthcare professionals in the first place are supposed to explain the attached X-rays documentation. A description that explains the reason for treatment and what the X-rays exhibit is very necessary.
  • A brief explanation that justifies the treatment must be submitted in printed format and digital X-rays.
  • Appropriate and accurate labeling and particulars like date on X-rays is much required.
  1. Frequencies, Exclusions and Limitations:

  • Usually frequencies, exclusions as well as limitations vary according to insurance plans.
  • The dental policy’s amount available actually depends on limitations like annual or lifetime maximums.
  • Patients will have to cover for only fewer years or few times a year for specific procedures along with frequencies.
  • Individual insurance plans usually covers replacement of crowns only five to seven years.
  • Many contracts have age group limitations for certain procedures based on patient’s age.
  • Hence, it’s important to get a copy of patient’s information along with certification of insurance that mentions exclusions, limitations of age and also benefits of plans prior to procedure performance.
  • In order to reduce frequencies of insurance difficulties or problems, new policies might occur especially to handle dental denials.

Hope you have got the information on dental denials. For more suggestions, please comment below. We will definitely consider them if relevant to the topic. For more queries on healthcare and updates, please subscribe to our blog.