How To Prepare Dental Claims? Everything You Need To Know

As a biller and coder in the dental department, one thing that will cause many challenges is claims. These are the applications that decide whether you will be paid the patient’s insurance or not. Insurance payers demand complete claim forms, strengthening their review process to approve a claim. But what if we provide you with an accurate way of creating dental claims?

Creating a claim is not child’s play. However, knowing some tips will help you ace the process and impress payers with your perfect claim.

Here we will explore the world of dental claims. We will try to explain anything from what is a dental claim to how to submit accurate claims for maximum payment chances.

What is a Dental Claim? 

A dental claim is a formal application submitted to respective insurance payers to receive reimbursement in return for the services provided to patients. This process is only done for insured patients because they have some insurance coverage.

Dental claims include detailed information about dental treatments, diagnosis, supplies used, and medical conditions provided to the patient along with calculated expenses for each.

The insurance company then uses this data to identify how much coverage a patient has left and thus they make payment.

Components of a Claim

A claim application has the following data included:

Patient Information

• Name
• Date of birth
• Gender
• Contact information
• Insurance policy number
• Group number (if applicable)

Provider Information

• Dentist’s name
• Dental practice name
• Address
• Contact information
• National Provider Identifier (NPI) number
• Tax Identification Number (TIN)

Insurance Information

• Name of the insurance company
• Policyholder’s name (if different from the patient)
• Insurance plan details
• Group number (if applicable)
• Subscriber ID number

Treatment Information

• Date(s) of service
• Procedure codes (CDT codes)
• Description of each procedure
• Tooth numbers and surfaces (if applicable)
• Diagnostic information (e.g., X-rays, charts)

Charges and Payments

• Itemized list of services provided
• Cost of each service
• Total amount billed
• Amount already paid by the patient (if any)
• Any discounts or adjustments

Supporting Documentation

• X-rays and imaging
• Diagnostic reports
• Treatment plans
• Patient consent forms
• Any additional documents required by the insurance company

Claim Form

• Standardized claim form (e.g., ADA Dental Claim Form)
• Completion of all required fields
• Signatures from the patient and the provider (if required)

Authorization and Signature

• Patient’s authorization for the release of information
• Provider’s certification of the accuracy and completeness of the claim

Preparing for Dental Claims

As you know what is a dental claim and its basics, let’s dive into the preparation of a claim application. Following are the steps for gathering documents for claim filing.

Verify Insurance Details

Before providing dental treatment, you must contact the patient’s insurance company and verify whether they are eligible for a specific service.

Many times patients don’t have coverage for some expensive treatments. As a result, when insurance payers don’t make reimbursements, the whole burden falls on the patient. This makes it difficult for them to pay the bill at once and thus the bill-receiving process becomes delayed.

This practice will also protect you from straightforward claim denials.

Patient Information

At this stage, you will need to have all the above-mentioned things to add to the application. This includes the patient’s personal information as well as their diagnosis data.

Here you must maintain all patient records just in case insurance payers ask for any. Also, complete documentation is the key to full reimbursement.

Another good practice is to make patients sign a consent form that they received certain treatment and for the transfer of their information (only requested) to the payer.

Coding for Claims

Now comes the coding stage. 

When you are done with the patient treatment, it is time to translate all services given and equipment used into universal codes that help insurance companies identify payable charges.

Commonly there are 2 types of codes used in dental billing:

CDT Codes (Current Dental Terminology)

These are the special codes used only in dental billing. CDT is created and managed by the American Dental Association (ADA) and is used to describe dental procedures and services in the bill.

ICD Codes (International Classification of Diseases)

These are the codes that help in identifying the reason for the performed procedure. It clears the context of dental procedures and verifies that the treatment was medically necessary.

These were the coding systems mostly used in the dental department. Now let’s have a look at the categories these codes fall into:

• Diagnostic codes
• Preventive codes
• Restorative codes
• Endodontic codes
• Periodontal codes
• Prosthodontic codes

You can also check out our list of dental billing codes.

Dental Claims Submission Process

Assuming that your dental claim is ready to be sent, let’s dive into the submission process that will yield a positive response from payers.

Choosing the Submission Method

You can submit claims using 2 resources:

Electronic Claims

Mostly, dental billing software is used to send claims to the payers electronically. These systems make sure your applications are error-free, thus resulting in more claims approvals.

Billing systems are also HIPAA compliant, which facilitates faster workflow while being under the compliance of regulatory authorities.

Paper Claims

These claims are prepared on a page by a human. Though it is an old-fashioned method for submission in some cases, paperwork is necessary.

However, this process may slow down efficiency and even contain high chances of errors. 

So analyze which claim submission method you can afford to have in your dental facility.

Tracking the Status

When sending the claim using either of the mentioned ways, you must keep an eye on their statuses. Whether the application is accepted, rejected, or taking too long to be reviewed by the payer.

At any point, you can contact the payer and boost the process speed.

This tracking will also help you record how many claims are paid and how many are rejected.

Claim Denials

Despite many considerations at every step of dental claims submission, some applications are rejected by the payer because of minor errors. These are called claim denials.

Denials are a nightmare for every facility because they result in substantial revenue loss if they happen on a large scale.

But there is a simple solution. Find out the error the payer has identified, remove that error from the claim, and resubmit. This way many claims will be accepted and thus your lost revenue will come back to you.

That’s why we emphasize using billing software to review claims electronically. It will identify and remove any error early on before submitting the claim.

Common Errors in Dental Claims to Avoid

Finally, you have learned the process of creating dental claims and submitting them to the payers for reimbursement. 

But there are some don’ts that you must keep in mind while preparing the claim application.

• Never use inaccurate or out-of-date CDT codes.
• The ADA Dental Claim Form should never have any fields left empty.
• Don’t forget to get the patient’s signatures.
• Never forget the deadline for submitting to the insurance company.
• Follow up on pending or rejected claims as soon as possible.
• Treatments requiring preauthorization should never be started without first receiving it. 

Ensuring Successful Dental Claims

As you see, submitting dental claims is no difficult task. All you need to know is the right process and tips to ensure accurate claim filing.

Not only will this process result in claim submissions, but it will also bring more revenue to your dental facility. 

To begin the process keep in mind our steps and see your every claim getting accepted quickly.