Get Your Claims Processed Quickly, Accurately

Posted by Kate Ranta on Apr 18, 2013 11:06:00 AM


The claims fulfillment process can be a drag. But we’ll let you in on a few secrets to help speed up the process. Here are some submission tips to follow to help guide you through the process:

General Recommendations

Let’s cover our bases. Check to make sure all necessary information is included on the forms.

Include on all claims:

  • Member name and I.D. number.
  • Treating dentist’s name, license number, and tax I.D. or social security number.
  • Address where services were rendered.
  • Date of service.
  • Procedure codes and description.
  • Amount charged.
  • Tooth number, surfaces, quadrants, locations, or arch and clinical diagnosis if needed.

Claim submission limitation is one year from date of service.

Radiograph Quality

The legibility of included radiographs are incredibly important. From the resolution of the image to the labelling.

All radiographs should be:

  • Current and of diagnostic quality.
  • Dated, mounted, and labeled right and left.
  • Labeled with patient’s name and provider’s name and address.

Periodontal Charting

Periodontal charts have an important job to play. They are the best way to uncover the difference between patients that are periodontally healthy and those with periodontal disease.

Charting must be:

  • Comprehensive full mouth analysis.
  • Legible and dated.
  • Documented with probing depths (six per tooth).
  • Recorded in millimeters per tooth.
  • Labeled right and left, mandibular and maxillary with classified furcation defects, tooth mobility, BOP (bleeding on probing) and CAL (clinical attachment loss) noted.

Written Narratives

Use this as a time to includes some key buzzwords that insurance companies can pick up on.

Narratives must:

  • Support need for procedure.
  • Describe specific conditions addressed by procedure.

For any questions, please feel free to contact Solstice’s customer service department at 877-760-2247

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Topics: claims, claims processing, claims fulfillment, submitting claims

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