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Filling Clean Claims

By: Dental Product Shopper

11/7/2022

Filing Clean Claims

“If you don’t have time to do it right, when will you have the time to do it over?” ~ John Wooden

Many practices are busy. This is a great problem to have. Unfortunately, being too busy sometimes leads team members to just “send the batch” and wait to see which claim pays and which claim doesn’t. While this may save 30 minutes to an hour of time on the front end, the amount of time it will take to get the claims properly paid will increase by at least 30 or more days. Let's not even mention the hassle of correcting claims that have been filed incorrectly.

It is always best to make sure you have done it right the first time, especially when filing a legal document, such as a dental claim. Take the time to file a clean claim.

Here are some questions to ask prior to sending out a dental claim:

Does the claim make sense? Do the procedure codes match the clinical notes?

There is a claim in the batch for a Crown (D2950), Build-Up (D2950) and Recement (2952)-all for tooth #3. The clinical notes read, "3 - Crown necessary due to large, old amalgam restoration with leaking margins and decay." This tooth did not have any existing crown, therefore this claim is incorrect.

Do the tooth numbers match?

It is human nature to make mistakes, so verify the tooth numbers accurately on the claim form with what is in the clinical note. Look at the - radiograph and make sure the indicated tooth is the same.

Does this code require additional supporting documentation by the dental payer, such as radiographs, photos, narrative, etc?

Know your dental payers and what documentation they require for each procedure and claim adjudication. For example, Cigna needs a seat date to pay for a crown build-up. I don't know why, but they do. Send them the seat date with the initial claim, along with anything else they need. If you don't know what they need, you can usually find this information on the payer's website.

Is the information listed on the claim correct and/or is anything missing (Subscriber Name, ID, DOB, Address, Relationship to patient, COB information)?

Take the time to look over the claim prior to sending it out. Are there any blank spaces that need information? If it is an insurance company who always requires an alpha-numeric ID, are there letters and numbers in the ID?

Is your Claim filing Software Up to date?

If your electronic filing software is updated regularly, it will flag most claims that need attachments, have coding errors (outdated coding) or eligibility issues (insurance has termed). This will save time and alert you to issues you may have missed when you initially checked your claims for errors. But remember, even if you have the latest version of your dental software or other electronic filing software, if the insurance company is not keeping up on their end, your software may not be flagging the errors.

For more detailed information check out our book, Dental Administration with Confidence, pre-oders for the 2023 edition are available NOW!

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