Tips to Get Dental Claims Paid: Essential Data for Carriers

Posted by Kate Ranta on Jun 10, 2015 11:30:00 AM


You’ve heard that time is money. Nowhere in your dental practice does that ring truer than in the turnaround time from submitting claims to receiving payments. With all that detailed paperwork, seemingly endless phone tag, plus lengthy phone calls, is there anything you can do to shrink that turnaround time?

The good news is yes…if you supply your carriers with the essential data they need to process it.Here are some tips to get dental claims paid more quickly.


The Electronic Option

Before we offer a checklist of all the data you’ll need to provide to carriers, here is an idea that may save you time—and money: electronic dental claims.

If electronic claims are an appealing option for you, talk to your carrier and be sure to sign up for a National Provider Identifier (NPI) to get your unique code. The code helps protect patient privacy in compliance with HIPAA regulations. You can apply for your NPI here.

Going paperless has a number of advantages. Your staff can complete claim forms more quickly and usually avoid the telephone dance. There will be less paper to file and for that, the environment will thank you.

If you choose to stick with traditional paper forms, however, there are still ways to save time and cut down that payment turnaround time. Here’s how.

Patient’s Personal Data

The form your dental office supplies to carriers must include all of the following patient information in order for the claim to be processed the first time around:

  • Name of patient (and parent/guardian where appropriate)
  • Patient’s date of birth
  • Patient’s social security number
  • Employer: company name and address
  • Name of insured employee
  • Name and address of carrier
  • Insurance group number

Clinical Data: Provide a Complete Picture

It’s true that different clinical diagnoses may require somewhat different information for claims to be processed successfully when submitted. What follows is a checklist for your office to use to avoid omitting data or forgetting the required accompanying items that might cause your payment to be delayed or worse.

Think of it this way: you want the carrier to “see” the patient’s tooth condition the same way you do. Working from that perspective can help guide you to what data needs to be included.

1. Images of the patient’s dental condition. Always send X-rays for claims on these procedures:

  • Scaling and root planing
  • Periodontal work
  • Posts, crowns, fixed bridges
  • Implants, prosthetics
  • Extractions

Submit copies of all your X-ray views and, if needed for further clarification, photographs as well. Make sure everything is clearly and specifically labeled. If the photo is a mirror copy, point that out.

If the patient’s current condition requires pre- and post-operation X-rays, send both sets. Don’t make the carrier do the research—that will cause delays in payment, not to mention more contact time with your staff.

The combination of X-rays and photos can provide the carrier with sufficient information for prompt payment.

2. Periodontal chart. If you submit a claim for periodontal work, always submit the chart with the claim form. Your chart must show dates and pocket depth measurements and should include other periodontal diagnostic information such as bleeding areas and gingivitis data.

3. Narrative descriptions. Here, the golden rule applies: send data to others as you would have them send it to you. In other words, be clear, be clinical, be brief but thorough, and be legible (if handwritten). Keep your goal in mind: providing enough diagnostic and treatment data to give the carrier a picture of exactly what condition you saw and specifically how you treated that condition.

4. Attachments. Office staff should check to ensure that the ADA claim form is complete prior to submission. Use the current form and the current CDT codes. Incorrect coding will cause delays in processing your claim and possibly even denial. Also include other related reports—pathology, for example, or outside consultations.

When More Information is Requested

If your carrier contacts your office for more information on a claim, step back and ask yourself what might not have been clear to a claim reviewer in your initial submission. Then submit as much information in image and narrative formats as needed to assist the reviewer’s ability to see the patient’s tooth condition and your treatment the same way you saw them.

Remember, too, that when your claims are processed and paid quickly, your patients will benefit as well. Patients don’t like worrying about their insurance payments either, so they will appreciate the no-hassle financial benefits of your office’s efficiency. That’s a great way to retain your patients who often will spread the word to their family, friends and colleagues—and help grow your practice.

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