Top 5 Reasons why Dental Claims are Denied

Like any other area of practice in medicine, dental practice treats hundreds of patients claiming to have health care insurance. As per the America Dental Association’s survey, approximately 65% of insured patients visit dentists for both major and minor dental treatments. Therefore, health care providers need to avoid denial of dental claims to get maximum reimbursement on time.

The following are the top five reasons resulting in the denial of Dental Claims.

1. Incorrect Patient Information: A lot of providers tend to ignore the errors in the dental claims form. Ignoring incorrectly filled patient information such as misspelled names, wrong insurance details, etc is one of the major causes leading to a denial of dental claims. It is because, in a world of technology, most of the claims are rejected by the software itself due to mismatched information. So, it is better to avoid errors in the claims form by opting for electronic claims transmission.
2. Delay in filing Claims: With so many insurance carriers it is quite tough to keep track of deadlines to file claims. A lot of providers fail to file claims on time as they struggle to manage dental practice and administrative tasks together. The only way to resolve this problem is to outsource dental claim services from a medical billing company. Getting professional assistance from a trained medical biller will result in the timely filing of claims. Also, the professional will ensure to follow the filed claims in case of any rejection or delayed payment.
3. Failure in getting Pre-Authorization: This is an extremely important step that providers tend to miss due to the extreme workload. However, it is advisable not to overlook pre-authorization. Getting pre-authorization for dental treatment is the only way to ensure reimbursement. Without pre-authorization, the insurance payer may deny the payment for the dental treatments even if they are covered in the insurance plan.
4. Non-Coverage of Treatment: It has been noticed that many providers fail to cross the insurance plan agreement for covered treatments. A patient may visit to you claiming to have insurance coverage of any dental treatment. But as a provider, you must ensure the coverage of dental treatment(s) beforehand. Failure to do will affect your organization’s revenue cycle because the insurance payer is not liable to pay for treatments that fall outside the insurance plan/policy.
5. Skipping Insurance Verification: Sometimes it so happens that a provider performs an intense dental procedure without cross-checking the patient’s claims to have an insurance plan. Later on, when the provider files the claim the insurance payer denies payment due to the non-verification of the said claim. Now in such a case, the provider is likely to face a huge loss due to an inactive insurance claim. Therefore, providers must not skip insurance verification to prevent denials and/or fraud.

In addition to the above, the Coordination of Benefits (COB) also tends to result in the denial of dental claims.

Failure to Cross Check COB: It may seem to be a minor step but it is essential to ask your patient about having multiple health care insurance plans. This information is valuable in billing the primary and secondary insurance payers after knowing the COB they share.