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Seven Dental Claim Issues That Lead To Delays & Denials

With an increasing number of Americans dependent on dental health insurance policies, dental billing has become an important element of the business. More than ever, dental clinics and practitioners must focus on establishing and submitting legitimate dental claims.

However, despite their efforts to improve dental billing and claims, the claim denial percentage has skyrocketed from 5% in 2007 to roughly 14.1 percent in 2010 and higher, reducing cash flows and revenues overall.

There are a variety of reasons why a dental claim is refused or delayed, and the only way to overcome this is to investigate those causes.

Seven Common Dental Claim Issues Leading to a Denial or Delay

To assist you in dealing with this looming issue, we have compiled a list of the seven most common dental claim issues that result in payment delays and denials.

1. Inaccurate References

The most important aspect of a dental claim is the insurance codes, which change every year. The incorrect reference of insurance codes is a common cause why most dental claims are denied or delayed.

As a result, it’s critical for dental billers to invest in billing and coding references and keep them up to date every year so that claims are rapidly accepted and reimbursed – growing cashflows and revenues to perfection.

2. Non-Existent Documentation

The importance of documentation in dental billing cannot be overstated. Most dental claims are refused or delayed due to a lack of paperwork.

Many dental clinics and practitioners place less emphasis on preparing paperwork, which results in claims being sent to insurance carriers with missing proofs and documentation.

Insurance companies are likely to check dental claims using reference documents, and if that is missing from the proof, your claims are very likely to be refused.

In some situations, insurance companies may perform an audit and sentence you to prison.

The best way to avoid this scenario is to take clinical notes using the SOAP method. It’s easy to understand if you think about it like this:

  • Subjective – the core problem communicated by the patient, illness history, severity, and location. 
  • Objective – vital signs of the patient and findings from the examination. 
  • Assessment – final diagnosis and the reasoning of diagnosis. 
  • Plan – treatment plan for the patient. 

Attaching such extensive data to dental claims could significantly speed up the procedure and reduce the likelihood of denial to nearly nil.

3. Outdated Insurance Information

Another major reason why most dental claims are refused or delayed is the use of out-of-date insurance information.

Insurance companies frequently update their plans and coverage policies, which must be properly included in the dental billing system for proper claim submission.

Since most patients neglect to update their plans and coverage, the dental biller’s primary task is to keep the system up to date in order to minimize delays or denials in dental claims.

4. Incorrect Claim Information

The submission of appropriate dental claim forms is the most important aspect of dental billing. The most common reason for dental claims being rejected or refused is the inclusion of erroneous information.

It is the job of dental billers to have a highly skilled and experienced personnel on board who can properly produce dental claims – all of which are error-free and infallible for successful submission and reimbursement.

5. Delayed Claim Submission

Each dental health insurance company has its own set deadline for filing dental claims.

When a claim is submitted after the deadline – it eventually results in denial. Therefore, it is always ideal to submit claims soon after the competition of your patient’s treatment.  

Most dental insurance companies have an expanded one-year deadline for claim filing; however, some of them might only extend up to 90 days. 

6. Non-Systematic Management

Most of us make the mistake of thinking that filing dental claims is just another duty. The truth is that it is a complex task with a lot of money and time at stake, therefore systematic management is the only way to ensure success.

Since dental billing encompasses all activities at your clinic, you must maintain effective communication throughout.

Each member of your practice should be included and requested to contribute to the creation and submission of the most just claim feasible.

Lack of Trained Staff

Since dental billing needs extensive exposure and knowledge of the processes and coding, finding appropriately trained personnel may prove difficult.

Most of the above-mentioned dental claim concerns that result in a denial or delay in payment are caused by insufficiently qualified staff.

Even if you hire the best people in the market, they will want some training and direction in order to understand your process and adapt smoothly.

To avoid these dental claim concerns, you must invest in your staff’s training and development.

If you believe that your training and growth aren’t yielding the desired results, it’s always a good idea to outsource your dental billing to a professional company or service provider.

This would greatly simplify your billing process and solve the majority of the issues you have with dental claims processing.

Wrapping Up

A denied dental claim is not the end of the road; you may always request a review. All you have to do here is pick a legitimate dental claim help company, and you’re done.

They are professionals who thoroughly grasp all of the regulations and practices and know exactly how to best send an appeal to the insurance company, resulting in your funds being refunded in the majority of cases.

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