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Dentist Billing More Than Insurance Approved

Dentist Billing More Than Insurance Approved We are all aware of the term Insurance, but Dental Insurance is the one people do not look forward to. In the past years, people did not look forward to dental Insurance as it was assumed to be unnecessary however along with time people are learning how important oral hygiene and health care are. Dentalrevu is here to shed light on the topic. Under the Affordable Treatment Act, coordinating care between medical and dental professionals is crucial for improving patient outcomes. The annual maximum payout from dental policies is typically quite low. In cases where the patient’s medical and dental problems are together, as a result the dentist may submit the claim to the patient’s medical insurance company. By maximizing their insurance coverage as a result patients will experience less financial strain.

How is Dental Billing Service crucial for Insurance?

Dentist visits require careful attention to the dental billing process. Dental Billing is preparing and submitting claims to insurance companies for payment for dental care rendered. Dental billers are responsible for keeping an eye on claims to ensure their company gets paid for the services rendered to patients. The productivity and profitability of a dental office need to be better with the help of a skillful dental biller so that the Dental Billing service is smooth.  We are sure that millions of questions would pop into your head regarding Dental Billing service and insurance; Revu Billing got it all covered.

Why is dental Billing important for Insurance?

Dental Billing looks closely into the case and then claims and submits the Insurance.

What is the time duration for dental Billing and Insurance?

Everything is crucially check; hence 30 to 40 days is the standard time.

Who is eligible for dental billing service?

The person who knows about treatments and procedures is eligible for the dental billing service.

Dental Billing and Insurance Procedure

Dental Billing requires time and practice. Following Is the procedure for the Dental Billing service:

Protocols of Front-end Medical Billing


Scheduling is the first stage in the registration procedure for processing insurance claims.

Eligibility Verification:

A dental office cannot bill a patient’s insurance company for services without ensuring that the patient’s Insurance covers dental care.

Payments Collected At The Point Of Sale:

When a patient arrives at the front desk ,you can ask them to pay their copayment, deductible, coinsurance, or the whole amount owed.

Form of Meeting:

Each time a doctor sees a patient, they fill out an interaction form (a superbill or fee ticket). Services rendered, diagnosis codes, patient information, and practitioner comments are all recorded here You can pay for the visit, ensure the doctor fills out the encounter form, and set up any  necessary follow-up appointments.


To enter charges, use the encounter form to confirm the services and their justification. After that, you’ll input the costs into the office management software. Note the patient’s current payments here.

Submitting the charges:

After entering the costs and payments, a claim is generated. There are a variety of tasks that could fall under this category, such as gathering charges, revenue codes, and more.

Claim scrubbing:

The term “scrub” refers to checking a claim for completeness and accuracy before submitting it. Scrubbing claims ensures that all required details, such as the patient’s name, the doctor’s name, and the service date, are.

Receiving Payment:

When seeking reimbursement from insurance companies, medical billers often submit one of two claim forms as both the CMS-1500 and the UB-04 are forms use to submit reimbursement requests.

Claim Submission:

Provider organizations (i.e., your company) can now electronically submit claims to payers. In most cases, medical billers will employ specialized software that complies with HIPAA’s rules for electronic filing.


When following up on claims, remember that your responsibility does not end at submission but each claim’s status should be check every day. If you employ a clearinghouse (a third party) to process your claims, they have a dashboard where you can check on their status.

Processing Payment:

After receiving electronic remittance advice (ERAs), paper cheques, or direct deposits, hospitals and doctors’ offices must post the funds. Remember that there are remittances that cost. Patients should be billed once an ERA has been entered. There must be a complete accounting of all outstanding debts. The date of service, services provided, insurance reimbursement received, money collected at the time of service, and reason for the patient    balance due should all be included on the statement.

Claiming Denial:

It is important to manage denials as soon as they are received, as they may affect your ability to get reimbursed. When a payer rejects a claim, they typically offer a denial code and brief reason through the ERA.

Revenue Collections from Customers:

You have reached the end of the medical billing process. Some patient accounts may inevitably be past due when collecting payment. Patients who have yet to pay within a specified time frame should be contacted again.

Credit Balances:

There are various reasons why a credit balance could occur, but medical billers still must identify overpayments as soon as possible and issue refunds to the appropriate parties. Failure to do so may result in legal action, monetary fines, and other repercussions.

List Of Things Covered Under Insurance:

Here is a list of procedures that dentists can bill to Medical Insurance:

Head and neck evaluations for orofacial medical problems

CT Scans

Panoramic X-rays

TMJ Services

Bone Grafts

Cyst Removal



Sinus Lifts

Dental Implants

Dental repair of teeth due to injury

Sleep apnea and/or mandibular repositioning appliances & services

Treatment related to inflammation and infection

Certain periodontal surgery procedures

Treatment to correct congenital malformations

Frenectomy (tongue surgery) for infants and children

Extraction of wisdom teeth under certain conditions

Removal of multiple teeth at one time

Infection is not treatable by entry through the tooth

The pathology that involves soft or hard tissue

Procedures to correct dysfunction

Emergency trauma procedures

Consultation for an excisional biopsy of oral lesions

Dental disease secondary to cancer treatment (e.g., mucositis and stomatitis)

Procedures Not Covered By Insurance:

Dental practices should be aware of the following potential coverage gaps when billing medical Insurance:

Preventive dental care that includes routine x-rays is not covered because they do not meet the criteria for a medical diagnostic procedure.

Tooth whitening and other cosmetic procedures are not considered medically necessary.

A referral from a doctor is typically required before Insurance pays for preventative tooth extraction.

Liability insurance should be invoiced first in the event of a severe injury covered by such coverage.

Allowed amount on Health insurance:

Allowed Amount With In-Network Care

If you go to a doctor who is part of your managed care network, you can take advantage of the lower rate your plan negotiated.

Providers part of a network charge more than the maximum allowed by law, but they receive payment for only the maximum amount. If you go with a provider within the network, they have to discount your bill by the proportion that exceeds the allowed maximum.

Customers are safe by only dealing with in-network providers.

Unfortunately, you’ll still have to shell over some cash. A deductible, co-pay, or coinsurance is paid. If additional costs arise, your health insurance will pick them up. 2 An insurance company will only help if you have met your deductible first. Insurance will kick in once you’ve paid that amount if a copayment is require. If the service has a deductible and you’ve already paid enough toward it, your insurance company will cover the rest of the cost.

We do not permit any additional fees. They will not be reimbursed if they are part of your Insurance network. Your health insurance company’s provider discount is reflected in the “amount not authorize” section of your explanation of benefits.

Allowed amount with Out of Network Care

Your health insurance policy’s maximum payout for services rendered by an out-of-network provider is the amount your insurer has determined to be fair and reasonable. The patient has no recourse against an out-of-network practitioner for any reduction in the amount billed by the doctor. There is no pre-arranged fee reduction between your health insurance and an out-of-network doctor or hospital.

Nonetheless, your health insurance company will only pay its share of the cost however if it falls within the plan’s allowable range, not the amount billed.

Wrapping up the Facts:

Dental Billing plays a vital role in Insurance; a single mistake can make the lengthy procedure the lengthiest.  There are specific protocols for the Insurance. When the dentist’s Billing is more than the Insurance approved, the further procedure depends upon the type of network care, namely In network care and Out of network care.

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