7 steps to sending clean insurance claims

2020 09 29 21 12 1653 Bond Ashley 400

One of the top reasons your insurance aging report may be larger than you would like is because your office is not sending clean claims. For a claim to be sent correctly electronically, certain steps must be performed and details included. Today, I will give you my seven easy steps to make sure that your claims are getting where they need to go, each and every day.

1. Check insurance eligibility before the patient comes in

Ashley Bond is the founder of Bond Dental Consulting.Ashley Bond is the founder of Bond Dental Consulting.

Patients often don't let us know about an insurance change when they come in for their dental appointment. When I'm calling on outstanding insurance claims, I can't tell you the number of times they are overdue because of insurance terminations. Checking insurance eligibility early is an easy way to get in front of these aging claims and catch would-be denials before the patient steps foot in the office. Dental software and insurance logins have made it easier than ever to check a patient's eligibility. I also have a free insurance login Excel sheet template.

2. Have all patient information correct in your dental software

You need key pieces of information from a patient to send off their insurance claims. Make sure you have a form for patients to fill out that has their name, address, and date of birth, as well as the identification or social security number of the subscriber. If you miss getting this information on the first phone call, you can always refer back to this form to make sure you obtain all the information needed to get paid by the insurance company. Better yet, get all this information before you even get off the phone with them initially, and have all of their information ready before their first visit.

3. Have all insurance information correct in your dental software

Speaking of details, also make sure you have the correct name, address, group name, group number, and payer ID for the insurance company. I've seen countless claims rejected due to no insurance address or the wrong payer ID attached. Take the extra step to double-check that all of this information is filled out in your software.

4. Take diagnostic x-rays preop and postop, as well as intraoral photos

Some of the greatest tools you have in your office to get paid by insurance companies are your x-ray machine and an intraoral camera. If you do not currently take intraoral photos, I highly recommend it; they are vital to combatting insurance denials. Take the extra seconds to double-check your x-rays and make sure they are of diagnostic quality.

5. Add the correct attachments

Not all claims are created equal. Some claims need that extra attention to detail. Insurance companies will typically reject claims for major procedures if they don't include the detailed information needed. Below is a cheat sheet on what you need to provide to send a clean claim for general offices. Remember: It is always better to send more information needed than less.

  • Crowns: x-rays, intraoral photos, narrative, initial or replacement
  • Bridges/implants: x-rays (include full arch), narrative, initial or replacement, missing teeth
  • Endo: x-rays and narrative
  • Scaling and root planing (SRP): perio chart, full mouth series (FMS) x-rays
  • Guards: upper/lower and narrative
  • Extractions: x-rays and narrative
  • Ortho: narrative

6. Check rejections daily

You should be checking your rejected claims often. Most rejections will have the exact reason why the claim was rejected, so you can fix it easily and instantly. Don't wait 30 days for it to show up on your aging report. Get it taken care of as soon as possible. Doing a little bit every day helps keep your workload down in the long run.

7. Run your insurance reports

There are four reports that I run at least monthly.

The first I like to call the "big batch." This is the toolbar button in Dentrix that allows you to batch any claims that have not yet been batched (INS button). You can change the date to as far back as you would like. I personally like to go back to the first of the month and batch it through that day. This way nothing gets forgotten. I like to do this daily when I send claims.

The second report is "procedures not attached to insurance." This report should be run monthly to find any procedures that snuck through and got lost in the batch and are not attached to an insurance claim. I like to go back a year for this report and dig deeper into what I find. This report can be found in the office manager and the ledger.

The third report is "secondary claims not created." This report will help you find those secondary claims that were not created after primary pays. You can set up your system for these to be created automatically after a primary payment is posted. However, if this feature is not enabled, or even if it is, secondary claims can still be missed, so make sure you are checking this report at least monthly, if not weekly. This report can be found in the office manager and the ledger.

The last report is "​insurance claims to process." This report will help you locate any claims that you created but, for whatever reason, never sent off to the insurance company. Generate this report at least monthly for your practice. The report can be found in the office manager and the ledger.

If you need any assistance locating any of these reports within your dental software, please reach out to me at ashley@bonddentalconsulting.com.

Those are my seven main tips to create clean claims every time. And be sure to check out more of my dental insurance freebies. If you are ready to decrease your stress and increase your profits and feel outsourcing your dental billing is right for you, shoot me an email and I will be happy to chat with you.

Ashley Bond is the founder of Bond Dental Consulting, a company that specializes in helping practices collect 100% of what is rightfully theirs. She has more than 10 years of experience in the dental field beginning at her father's dental practice, where she saw the ins and outs of everything the business entails.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.