For many dental businesses, insurance claims account for close to half of your overall revenue. So when claims are consistently denied, much of your revenue is delayed — or in some cases, never collected. For fast and dependable dental insurance claim reimbursement, use our checklist to guide you on these 4 must-have details.
Dental insurance companies don’t make it easy to receive reimbursement upon your first submission of a claim. Instead, they use the smallest excuse to return a denial, then you have to be quick to turn around your resubmission with the accurate or missing details.
And when we say quick, we mean it! The claims game has a ticking clock — unpaid claims will eventually reach their timely filing deadlines, where insurance will no longer accept the claim for payment.
Dr. Bicuspid explains, “You treat a patient, submit the claim to the insurance company, and wait for the reimbursement. However, it's common for there to be another step in the process: submitting more information to the insurance company, so the claim can be approved. This means not only more time and effort for your back office staff but also delays in payment.”
All this additional work is also taking away from the time your team can spend engaging with in-office patients and shaping a pleasant patient experience.
Insurance claims filing is tedious, repetitive, and requires deep attention to detail — and it is essential to the success of your dental business. So how does one avoid the extra work and get it right on the first try to get paid ASAP?
We’re here to make insurance billing easier for you and your team. Here are 4 things your claims need for prompt reimbursement.
Key takeaways on receiving fast dental insurance reimbursement:
- It’s better to include “too much” information and documentation than not enough
- Submit insurance claims as soon as you can (within 24 hours of treatment, ideally)
- When in doubt, ask the insurance company what they require
✅ Must-Have #1. The correct claim form
Whether the procedure is considered medical or dental will determine which form you'll use to officially request payment. Determining when you’re going to file a dental claim versus a medical claim can be a huge hang-up for dental teams — and a big hold-up for their insurance claims.
It’s hard to know when is the right time to use which form, and if they get it wrong, there could be delays on when the dental practice gets paid.
If you don't first make a call to the payer to confirm, and you just submit a dental claim when it should be medical, the insurer will return an explanation of benefits that clarifies: “Medical is primary, please submit to medical and start the process over.”
This setback can be costly if you’re close to the timely filing limit. But that’s only if you get it wrong. Here’s how to get it right…
There are 3 types of procedures that will require a medical claim form (CMS 1500) instead of a dental claim form (ADA Dental Claim Form):
- Oral surgery
- Trauma (broken jaw, broken tooth, or broken teeth)
- Pathology
This is a common source of confusion, so when in doubt, it’s best to call the medical and dental insurance companies to confirm which to send.
For more on how our client-partners tackle handling medical and dental insurance, download the case study below:
Pro Tip: Filing the right type of claim for the procedures performed is key to creating claims that are paid promptly.
✅ Must-Have #2. Accurate dental patient information
You have to gather all the right information from the patient at the start. This step is all in the hands of whoever speaks to the patient when they call to make an appointment. This information should be verified when the patient comes in for their appointment, which may be weeks or months after the initial call.
When the patient calls your office to schedule a dental appointment, you’ll get their full name, birthdate, address, and then all of their insurance details. When it comes time to file the claim, their personal information will be just as important as their insurance information, so it’s imperative you verify the spelling and numbers are correct.
It seems straightforward, but you’d be surprised how many claims are denied due to inaccurate patient information. A lot can happen in those weeks or months between scheduling their appointment and showing up for it.
Addresses change all the time! Names do, too, as people marry and divorce. Not only do their address and date of birth need to be accurate, you need to also have spelled their name correctly. When in doubt, take the few seconds to confirm by asking the patient to spell it out.
Yep, these small mistakes can cause a claim to be denied. So, when the patient comes in for their appointment, the easiest way to confirm is to verify all the information again by looking at their driver’s license and insurance card.
Pro Tip: Scan these cards and save the images to the patient's account as a failsafe.
✅ Must-Have #3. Accurate billing entity/provider information
Now we get into the nitty-gritty: insurance information, the other vital part of insurance verification — which should be a routine step at the start of your billing process.
Another reason claims are denied is because of inaccurate policy details. When receiving the patient’s insurance plan information, the following information must be correct. This array of information is everything else you’ll need to check a patient’s eligibility and obtain a full breakdown of their benefits:
- Insurance provider name
- Insurance provider address
- Insurance provider telephone number
- Member ID number
- Member date of birth (DOB)
- Patient DOB, if different from the Member
- Employer name
- Group ID number
After you obtain this information, you must confirm the patient’s coverage is currently active, what procedures are and are not covered, and the percentage of the costs they cover for the planned procedures.
This step can be done in your insurance verification software, or you can call the insurance company directly to verify all of this information.
If your team enters all the patient’s information into your dental software accurately and verifies the patient’s benefits, there should be no problem in sending a claim that will be accepted the first time and paid by insurance promptly.
✅ Must-Have #4. Appropriate attachments and documentation
Different procedures require different attachments and documentation. These are visual proof and detailed explanations for why the services performed on the patient were necessary. Oftentimes, a simple note stating why a procedure was needed will not satisfy an insurance provider’s requirements.
Claim details can be neglected by a busy dental team caught up in everyday tasks — they simply forget to attach x-rays or intraoral photos.
But to be paid promptly with a first-time claim submission, it’s a good practice to always “over-explain” by providing as much information as possible on every insurance claim.
Supporting attachments and documentation come in the form of:
- X-rays
- Periapical (PA)
- Panoramic (Pano)
- Full Mouth X-ray (FMX)
- Intraoral photos
- Clinical notes
- Charting
- Narratives
Read more: Dental clinical notes: 3 reasons they are crucial to your success
Your dental team must keep up with each payer’s attachment and documentation requirements to avoid claim denials and delayed payments. 
Specifically, different CDT (Current Dental Terminology) procedure codes require different types of attachments, such as a variety of x-rays or intraoral photos. As you probably know, CDT codes are added, removed, and changed every year, so it’s possible their required attachment could change each year, as well.
For this reason, always take intraoral photos of the original condition prior to treatment. Even if a specific code asks for an x-ray, these intraoral photos document your clinical findings and show what the naked eye sees — covering all the bases in case a payer changes the rules.
Either way, showing the original condition will be essential if you need to appeal a denied claim.
Don’t let small mistakes create big delays in your cash flow and extra work for your team
To recap, here are 4 things your dental insurance claims need for prompt reimbursement on their first submission:
- Must-Have #1. The correct claim form
- Must-Have #2. Accurate dental patient information
- Must-Have #3. Accurate billing entity/provider information
- Must-Have #4. Appropriate attachments and documentation
Accurate claim submission means you’ll be paid faster, and your revenue cycle keeps moving at the pace of your production.
When there are halts in your revenue cycle, you’ll see drops and delays in cash flow that will affect your daily operations, as well as your bottom line. So, be sure to refer to this checklist if you ever question what to include with an insurance claim.
DCS provides end-to-end revenue cycle management services, including insurance billing.
While your team will still create claims with proper attachments and documentation, our team will check claims for completion, submit them for reimbursement, and follow-up on each claim until it is paid.
This kind of support for claims work has transformed dental team’s revenue and workflow. Here’s what a happy client-partner wants you to know:
“We are a small dental practice with a sole practitioner, one assistant, 2 hygienists. I am the office manager and the only person at the front, and having DCS take over all our insurance claims, payment posting, and working on any insurance errors has been life altering! DCS is the best employee you don't have. Make the call!” –Tom Touhey, DDS
Get the claims support you need to collect on all your production: Book a free 30-minute consultation with DCS today.
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Dental revenue resources from Dental Cashflow Solutions (formerly Dental Claim Support)