Most claim denials are the result of incomplete claims or inaccurate information on claim forms. Below you will find a list of some of the most common claims filling errors that often result in denials or delayed claims processing and some tips on how to avoid them.
- Not using the current version of the ADA Claim form
- Incorrect treating dentist information - Claims should not be submitted with the billing entity/dentist as the treating dentist. Claims should always be submitted with the treating dentist’s information. Ensure the treating dentist name, license number; NPI, TIN number and location are clearly identified on the claim form.
- Neglecting to include all pertinent or correct information about the patient and the subscriber on the claim - Claims should not be filed with patient nicknames and date of birth and ID number should always be verified)
- Not using accurate dental terminology (CDT) codes
- Sending claim forms to the wrong payer
- Omitting the treatment date of service
- Using the “remarks” section for information not related to a treatment-specific narrative. - Using the remarks section for other comments, such as “payment expected in 7 days,” can needlessly delay claim processing. When there are comments in the remarks section, the claim has to be reviewed by a human being versus being adjudicated through an electronic process which will automatically delay claim processing.
- Not including appropriate documentation when the claim is initially filed – Most insurance carriers have posted guidelines documenting procedures that require additional documentation and what should be sent. We have compiled a list of some of the guidelines for some of the major companies here in our insurance center.
- Neglecting to include the date of previous placement for crowns, bridges,
or removable prostheses.
- Improperly responding to requests for additional information – With most insurance carriers when additional information is required, a new claim form should not be submitted. In most cases, doing so will result in a claim to be denied as a duplicate submission. Instead, just update a copy of the Explanation of Payment to include the requested information and/or a brief explanation of your reason for the re-submission.