7 Ways to Improve Claim Quality & Reduce Denials

Save time, reduce frustration, and have insurance claims paid faster!

Insurance carriers are constantly updating their requirements for reimbursement. This means the rules of the game are changing regularly, and if you’re caught unawares, your claims will keep coming back denied. Let’s explore what insurances are looking for on a claim in order to timely process payment, what Dentrix tools you should be utilizing, and why you need to review each claim for accuracy prior to submitting.

The quality, or cleanliness, of each insurance claim directly impacts the likelihood of approval and the speed of payment and processing. Here are seven ways you can improve the quality of your insurance claims so they are squeaky clean and less likely to be rejected — saving you time and money on appeals, write-offs and suffering cash flow.

1 – All providers are credentialed as soon as they are ready to join the practice.

Best practice is to start the credentialing process for a new provider as early as possible. If you are unable to obtain the necessary information to start the process, have an internal protocol for scheduling patients with that provider. An important question to ask when credentialing a provider is if credentialing will be effective on application date or approved date. This will help you with scheduling and claim submission.

2 – Submit in the Most Current ADA format.

If your claims are continuously rejected by your clearinghouse or not on file with insurance companies, you may be using the incorrect ADA claim form. The current ADA format for claims is the 2019 form, which is available in Dentrix G7.3. Once you have the correct claim format chosen, Dentrix will generate all claims on that new claim form.

3 – Use the correct CDT codes for the procedures completed.

With coding changes and additions happening yearly, best practice is to match the CDT code with the nomenclature — or the code description. Submitting the correct CDT codes on the claim holds the door open for more successful appeals if the insurance carrier denies services. There are several coding resources available, but my personal recommendation is the 2022 CDT Edition of Coding with Confidence.

4 – Maximize your claim refunds.

Does your practice charge out full office fees or PPO fees on the ledger? Whatever your practice preference, it is highly recommended to have the UCR costs on the outgoing claim form. The insurance EOB will state if a non-covered service can be billed to the patient with the full office fee. If there is no PPO discount on non-covered services, the patient is responsible for 100% of the office fee. Check here for your state allowances on billing full office fees to patients.

5 – Submit under the correct rending provider.

Check all claims for the correct credentialed rendering provider before sending them to the insurance carriers. If the rendering provider is an associate provider, confirm that the billing provider is correct on the claim as well. Hygienists are not rendering providers that need to be listed on the claim, only the doctor that performs the exam is the rendering provider.

6 – Always have accurate patient insurance information.

The quality of your insurance verification is directly correlated to the quality of your claims. The number one reason why claims don’t get processed is due to incorrect patient and/or insurance information. With 65% of offices being insurance driven, verifying and reviewing the insurance information is crucial to healthy revenue cycle management.

7 – Don’t forget to include documentation and attachments.

To send a squeaky-clean claim, you need SOAP, which is a format for clinical notes that stands for:

  • Subjective — The patient’s chief complaint as communicated by the patient, history of present illness, location and severity.
  • Objective — Vital signs, examination findings, health history update.
  • Assessment — Diagnosis, reasoning/evidence behind the diagnosis if applicable.
  • Plan — How the provider will treat the patient’s concern.

It is important to have clinical notes dated and with all signatures of the clinicians. This means the rendering provider (dentist) and then the hygienist or dental assistant that assisted with the visit.

The necessary attachments for services differ depending on the insurance carrier, but typical, critical supportive clinical documentation includes: current periodontal charting, current pre-op
X-rays, and pre-op and post-op intra-oral photos. Be sure also to include the date of prior placement of a crown, bridge or denture if you are replacing an existing restoration.

Sending clean claims daily ensures timely reimbursement and steady cash flow for your practice. Don’t let your claims pile up. Outsourcing your dental billing processes to eAssist Dental Solutions unburdens the in-house team from the heavy workload that is outstanding insurance collectibles. Combined with the powerful, user-friendly Dentrix practice management software, you can drive the success of the practice, feel confident that your practice is using best insurance billing practices, and finally start collecting 100% of what you are owed from insurance carriers.

Learn More

If you would like to learn more about adding a team of insurance claim and collections experts to your Dentrix solution, visit https://campaign.dentrix.com/eAssist.

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By Lindsay Salazar, Dental biller and Dentrix user of 22 years, eAssist Dental Solutions