5 TIPS TO RESOLVE OUTSTANDING DENTAL CLAIMS

Understanding dental insurance policies and how to resolve outstanding claims is crucial for every office. Whether you’re a PPO office, Medicaid office, or Fee For Service office, dental insurance is important to your patients and directly impacts their experience in your practice. Today we’re sharing 5 tips to help ensure the dental claims for your patients are paid!

1. UNDERSTAND POLICY LIMITATIONS AND EXCLUSIONS

There are different types of dental insurance policies available, including preferred provider organizations (PPOs), health maintenance organizations (HMOs), and fee-for-service plans. It is important to understand the type of policy you have and how it affects the coverage. PPOs typically offer more flexibility in choosing dentists but may have higher out-of-pocket costs. HMOs require the patient to choose a primary dentist from a network and may have lower out-of-pocket costs but less flexibility. Fee-for-service plans allow the patient to choose any dentist but may have higher premiums.

In addition to understanding the type of policy the patient has, it is important to know the coverage and limitations of that plan. Dental insurance policies often have specific coverage for preventive care, such as cleanings and exams, as well as coverage for restorative procedures like fillings or crowns. However, there may be limitations on coverage for certain procedures or waiting periods before certain treatments are covered.

2. CONSISTENTLY TRACK OUTSTANDING CLAIMS

How often do you run your outstanding claims report? Monthly? 2x/month? Weekly?

Consistency is key to resolving outstanding insurance claims. Select a cadence that aligns with your practice. Here are our recommendations:

MEDICAID CLAIMS
- 2x/month: Some states (TX for example) have very strict timely filing deadlines not only for the initial claim submission but for any information requested)
PPO CLAIMS
- 2x/month: If you accept EFTs from most PPO payers and have a generally clean AR then you want to run this report roughly every 15 days
- 1x/month: If you are still receiving checks from payers or your AR isn’t as clean as you’d like it to be, we recommend running the report monthly
FEE FOR SERVICE
- Varies: Depending on how your fee for service practice is set-up, the cadence will vary.
  - Patient pays in full at time of service and their insurance reimburses the patient: as needed based on patient requests/denials
  - Assignment of Benefits: use the suggested cadence for PPO claims

3. MAKE A NOTE

This step is frequently skipped but an updated claim status note is CRUCIAL to resolving outstanding insurance claims. Adding a detailed claim status note will not only be a reminder next time you look at the claim but it also is a great way to communicate to other members of the team that you’re actively working the claim while giving them an update on where that claim is in process.

MODPractice recommends including the following information:
Current status of the claim, rep and/or reference number, what actions you’re taking to resolve the claim.

Taking 30 seconds to make a note will help your outstanding claims process TREMENDOUSLY.

4. CHECK YOUR PROCESSES

More often than not, there are steps in the insurance verification process and/or claim submission processes that are causing claims to not be paid. Check out our other Tuesday Tips for help with submitting clean claims.

5. FOLLOW UP

Never assume the claim will be processed! Following up with the payer is crucial to resolve any outstanding issues. By being proactive and persistent, you can ensure that your claims are processed in a timely manner and that any disputes or discrepancies are addressed promptly.

One way to follow up is to check the status of the claims online. Many insurance providers have online portals to check the status of outstanding claims. Just because that rep told you the claims was reprocessing, don’t assume it is! The most efficient way to check and see if a claim you worked is processing is to check the portal 7-10 days after you worked the claim.

Thank you for reading our Tuesday Tips! Please check out our other articles and feel free to reach out with any dental billing questions.