What are the Main Reasons for Dental Claim Denials?

by | Last updated Feb 7, 2023 | Published on Feb 6, 2023 | Dental Insurance Verification

Reasons for Dental Claim Denials
Share this:

Poor management of claims can negatively impact any facility’s healthcare revenue cycle. Claims getting denied will increase the time it takes for providers to get paid for the services rendered. There are many complex steps involved in the dental billing and claims submission process. While submitting claims, it is critical for providers to be aware of the common dental billing errors and avoid them. Correcting mistakes and resubmitting claims is a costly and time-consuming process. Professional dental billing companies can help practices ensure efficient claim submission.

Key Reasons for Dental Claim Denials

Key Reasons for Dental Claim Denials

Incorrect/incomplete patient demographic information

  • Collect and verify all information upfront

Not verifying insurance eligibility and coverage

  • Properly verify insurance benefits to enhance patient experience

Coding mistakes

  • Avoid upcoding, down coding, and billing for services not rendered

Not handling bundling right

  • Check claim submissions against the EOB forms

Not filing claims on time

  • Submit claims as soon as possible after services are provided

Not knowing when to file a dental claim

  • Know the specific payer rules to avoid denials

Submitting claims without supporting documentation

  • Proper documentation supports medical necessity

Partnering with a dental billing company helps to avoid these dental billing mistakes and ensure an efficient and smooth dental billing process. Such companies provide the services of certified coders who stay updated on CDT and ICD-10 codes. Professional billing specialists also check claims for errors, such as duplicate billing, that can cause denials and correct these issues.

Loralee Kapp

Since joining our RCM Division in October 2021, Loralee, who is HIT Certified (Health Information Technology/Health Information Management), brings her extensive expertise in medical coding and Health Information Management practices to OSI.

More from This Author