How to Appeal Denied Dental Claim Denials or Rejections

by | Published on Sep 20, 2022 | Podcasts, Dental Insurance Verification (P) | 0 comments

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A reliable dental insurance verification company in the U.S., Outsource Strategies International (OSI) has a team of experienced insurance verification specialists. Our team collects and verifies patients’ insurance status prior to the office visit and provides practices with detailed benefits information.

In today’s podcast, Amber Darst, one of our Solutions Managers, discusses the process of handling dental claim denials and rejections, and how to appeal them.

Podcast Highlights

00:40 ADA’s Recommendations on How to Appeal for Payment

01:38 Insurance Verification Helps Prevent Claim Denials

Read Transcript

Hi, this is Amber Darst, Solutions Manager for Managed Outsourced Solutions and for this podcast, I’ll be discussing the process of reducing claim denials by completing dental insurance verifications before the patient’s date of service as well some tips for appealing any denied claims.

Dealing with the insurance companies regarding claim denials is not only frustrating, but very time consuming. Often claims will get rejected due to missing patient details,errors in the submitted codes or the lack of verifying each patient’s dental eligibility.

00:40 ADA’s Recommendations onHow to Appeal for Payment

When you do encounter a denied claim, here are the ADA’s recommendations on how to appeal for payment.

A proper appeal involves sending the carrier a written request to reconsider the claim and should

  • Include additional documentation that provides the carrier a clearer idea of why the treatment is recommended
  • It should provide the dentist consultant as much information as possible, as they will only be checking the dental claim form
  • Follow specific instructions provided by the particular carrier including the submission of the appeal in writing within the time allowed by the carrier
  • You should send your appeal letter to the specified department of the carrier and ensure it is in the form that the carrier requires and
  • should also include the word “appeal” in the title and the text of the document and in any cover letter that accompanies the appeal document

01:38 How Insurance Verification Helps Prevent Claim Denials

As I mentioned earlier, appealing for denied claims can take a while to resolve and can greatly hold up your reimbursement. The best way to ensure a better claim acceptance rate is to complete a thorough insurance verification for each of your patients before they are seen in the office. An understanding of their specific insurance benefits and requirements from their carrier allows you to submit clean proper claims from the beginning and also gives you the opportunity to discuss any out of pocket expenses with the patients before the procedures are performed. Consider outsourcing your insurance verifications to an experienced dental billing company such as MOS. We can assist you with this time consuming but very important task, keeping your front office staff available to focus more on patient care and customer service.

And that’s all for this! Thanks for listening in.

Amber Darst

Amber Darst is our Solutions Manager in the Healthcare Division, Practice and RCM. With a rich background in dental services, her expertise ranges from insurance coordination to office management.

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