Dental Billing and Coding Tips for Claim Settlement Delays

June 10, 2014

Delay in claims settlement is one of the major reasons of reduced profitability for dental practitioners. This is despite the introduction of favorable medical billing and coding changes in the healthcare industry. With more than a few dentists having to leave 16 - 30% of their revenue on the table due to rejected claims, further delay in the claims settlement can negatively impact the overall financial viability of their dental practices. Even though it is not restricted to dental billing alone claims settlement delays due to carrier processing and specification becomes more common with the cross coding concept frequently adopted by dental billers.

Following dental billing and coding tips can help your dental practice cope with claims settlement delays and further reduce the delay period over a long term -

  • Clarify cross coding complexities and intricacies with the insurance carrier in the claims proposal itself. Most claim settlement delays happen due to initial incomplete information or confusion in the documentation pertaining to the proposal. By simply clarifying the procedures that are cross coded in your dental claims you can save the processing time.
  • As soon as the insurance company receives your claims proposal they confirm the coverage of patient and the extent of it first. By ensuring eligible coverage of patient in advance, you save on time that is spent by the insurance carriers behind this procedural formality. However, to achieve this, your billing team should adopt the practice of collecting coverage related information from patients at the time of walk in.
  • Share all relevant data of patient with the insurance carriers in the claims proposal.. In the event of any missing information most carriers have a specific procedure and a pre-specified time frame within which the dental practitioner should provide the requisite information and close the query. This period invariably gets extended as most dental practitioners are not able to revert with the required documents and patient records within the specific turn-around time. Thus, it is essential that your dental billing team follow up with the filed claims and aggressively track its processing. This way, any documentation related queries by the carriers can be effectively resolved, expediting the claims settlement process as a result.
  • Avoid non-disclosure of information - both intentional and inadvertent. Sometimes dental practitioners refrain from sharing complete patient records with insurance carriers such as health status, occupation, physical disabilities, habits, etc. While this may allow better adherence to HIPAA guidelines it can still hamper your processing of claims and give way to another claims rejection or even worse, a medical audit. Therefore, share all the relevant patient and procedural information with your insurance carrier.

Even though these tips are simple to adopt in your current billing and coding practices, you may face various challenges in pursuing your carrier for speedier claims settlement. MedicalBillersandCoders.com can become a valuable billing partner for your billing service in such scenario. Our dental and medical consultants follow up each claims proposal and appeals to ensure timely settlement and improved profitability for your dental practice.


Category : Accounts Receivables / Claims Denials