4 Tips for Filing Insurance Claims

Four things you should be doing when submitting claims to help minimize delays and denials. 

In most dental offices, insurance payments make up a large portion of the office’s overall collections. Therefore, it’s important to file accurate dental insurance claims in order to get them paid as quickly as possible. One way to do that is to make sure you are filing claims with all the applicable information the first time, to avoid delays in payment. Here’s some tips to help you get paid faster.

Include a Detailed Narrative

A well written narrative on an insurance claim can be the difference between a payment and a denial. Train your clinical team to make detailed notes about why procedures need to be completed that you can include on the insurance claim. Procedures such as crowns, bridges, implants, and scaling and root planing will all require a narrative. Your clinical team can document the need for the procedure in the Clinical Notes, which you can then copy into the Remarks for Unusual Services area of the claim form. They can also document this type of information in the Procedure Notes, which can be copied directly into the Remarks for Unusual Services by selecting the Notes from Procedures option.

For procedures that always use the same narrative (for example, nitrous oxide), you can create claim remarks templates, which can then be added onto the claim.

Attach Clinical Evidence to Support the Claim

Be sure to attach clinical evidence for the insurance to review along with the claim. Include X-rays, periodontal charting, and intraoral photos. Digital records and X-rays make attachments quick and easy. You can attach X-rays directly from Dexis or Smart Image, periodontal charting right from the Perio Chart, and you can import files and use the screen capture feature for other types of attachments.

If you are filing a secondary claim, you can attach the explanation of benefits from the primary insurance carrier from the Dentrix Document Center. Adding all necessary attachments the first time makes a big difference. If you forget to add attachments, you have to wait three to six weeks to receive the explanation of benefits requesting the attachments, and then an additional three to six weeks to finally receive payment.

Be Sure Insurance Information is Accurate

This may sound silly, but make sure you have the correct mailing address and payor ID for insurance claims. If this information isn’t being checked and updated on a regular basis, it could cause claim delays. When entering a new insurance plan for a patient or when updating a plan, always check the mailing address and payor ID to be sure they are correct.

Read eClaims Reports

When you receive eClaims reports, be sure to read them thoroughly. They will provide you with a warning if you’re missing required information like an attachment or a narrative. Claims missing critical information such as subscriber ID won’t be sent and will alert you there is a problem.

eClaims also sends you reports on previously submitted claims. This can alert you to problems such as if the subscriber is not found by the insurance. This allows you to work on the issue without having to wait for the explanation of benefits from the insurance company. You can contact the patient to verify their information or find out if they have a new dental insurance plan.

Dentrix can help with automatic attachments. Dentrix G7.3 introduced a feature to automatically add attachments required by insurance companies. Automatic attachments eliminate the possibility of forgetting to manually add the attachment. Automatic attachments are based on the procedure code on the claim and the requirements for that particular insurance company. Dentrix has this information entered by default, but it can also be edited, and you can add to the list as you learn about additional attachments that are required by the insurance company.

Submitting claims properly with all necessary information the first time can help your office get paid by dental insurance companies faster. Since dental insurance payments generally contribute a significant percentage of a dental office’s overall collections, having a quick turnaround time from submitting claims to receiving payments is crucial. It helps to keep accounts receivable current and have a healthy cash flow.

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By Charlotte Skaggs
Certified Dentrix Trainer and The Dentrix Office Manager columnist

Charlotte Skaggs is the founder of Vector Dental Consulting LLC, a practice management firm focused on taking offices to the next level. Charlotte co-owned and managed a successful dental practice with her husband for 17 years. She has a unique approach to consulting based on the perspective of a practice owner. Charlotte has been using Dentrix for over 20 years and is a certified Dentrix trainer. Contact Charlotte at vectordentalconsulting@gmail.com.