Top 10 reasons your dental insurance claims can't be collected

When you partner with a dental billing company, you might expect to be free of all claims work, and that’s mostly true. The more tedious parts of claims management—submissions, appeals, and follow-up—are off your plate. But you and your team are still valuable partners in getting your claims paid promptly.

When you work with Dental Claim Support (DCS), you’re not just outsourcing claims work, you’re entering into a productive and profitable partnership. Our role is to take the daily burden of routine insurance billing off your plate, while your role is to provide us with the information needed to do that.

We’ve been managing dental claims since 2012, so we’ve built tried-and-true systems that run seamlessly—but even we hit roadblocks sometimes. When that happens, we’ll reach out to our point of contact. Why?

Because your office is the only source for patient information and clinical documentation, and without key details, it’s difficult—and sometimes impossible—to move a claim forward.

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If you’re ever concerned about a claim that hasn’t been paid yet, rest assured—there’s always a good reason, and we’ve communicated with your team to make a clear request.

 So you’ll know what to expect, here are the top 10 reasons our team may reach out to your office. When we work together to resolve these quickly, claims get collected faster.

Key takeaways when working with DCS to get your claims paid: 

• Clean claims require communication and collaboration.
• Small mistakes cause big setbacks—and slow cash flow.
• Faster payments are the result of a successful partnership.

Reason #1. Clinical notes are missing or incomplete

Your designated billing specialist isn’t in the dental office with you, so they can’t record notes or provide evidence on what happened during the patients’ treatment—that’s when the productive partnership with your team is essential because only they have access to the missing information.

Why it matters: Insurance carriers require clear and complete documentation that supports the claim.

Clinical notes are where you document your patients’ personal and clinical information in detail. These multipurpose notes are then used as a claim attachment, added to your patient’s medical history and included in your office’s records. Without requisite attachments on the insurance claim, insurance doesn’t have proof of what happened during the treatment, and they will respond with a quick denial.

Here's how to get your claims paid promptly:

Always complete clinical notes the same day of treatment and make sure they include necessary details, including: 

• The patient’s name and contact details
• The patient’s up-to-date medical history
• Their prior and current treatment information
• Canceled appointments or unscheduled treatment to document when or if you have offered treatment to a patient that has been missed, declined, or hasn’t occurred
• Prescriptions and medications dispensed or injected during the appointment, including dosages, frequency, and other details 

Once your team supplies us with this information, we’ll return to getting your claim paid ASAP.

Reason #2. Case narrative lacks details

Narratives are the part of your claim that tells the story of why the patient needed treatment and which treatment they received. This is more information we don’t have access to. It’s up to your team to ensure a detailed narrative is provided. 

Why it matters: Insurance companies require clear and complete narratives—vague or obscure narratives will be rejected.

Similar to clinical notes, dental insurance claims require an explanation of why treatment was necessary and how that treatment proceeded. Dental narrative mistakes can lead to claim denials that keep your practice from collecting the income you’ve earned.

Here's how to get your claims paid promptly:

Provide a detailed and clear narrative with every insurance claim. Avoid stock narratives—pre-written dental narratives that include keywords that insurance companies can pick up on. Keep the narrative concise and to the point, and include information an insurance company would not glean from inspecting an X-ray or photograph.

Read more: 3 dental narrative tips that lead to insurance claim acceptance

Reason #3. Patients are unaware of Coordination of Benefits rules

Patients rarely understand how their primary and secondary insurance coverage works, so they might not even know to tell you they are covered by multiple providers. That’s a detail uncovered during pre-treatment insurance verification or their in-office treatment presentation. 

Why it matters: Claims must be filed to primary and secondary insurance carriers in the correct sequence.

There are 10 standard situation-specific rules to Coordination of Benefits (COBs) that determine which insurance is primary and which is secondary. It’s a topic we often see dental teams struggle with, and we’re here to help! But you have to clue us in. We talk to your payers, not your patients—we recognize that managing the patient experience is your specialty.

Here's how to get your claims paid promptly:

Verify every patient’s insurance before their treatment and educate them on the impact of primary and secondary insurance on what they pay. If you’re unsure, you can turn to your point of contact at DCS with any Coordination of Benefits questions you have.

Reason #4. Insurance policy or plan changes due to a new job, a lost job, or other life change

Most patients’ insurance policies or plans update annually, but they might also have a new insurance carrier due to a job change, a marriage or divorce, or a relocation. And if they’ve visited your office within the past year, you might assume their insurance hasn’t changed—but  always verify, as a lot can change in 12 months.

Why it matters: Current policy details are required to understand a patient’s coverage and submit a claim to the correct insurance carrier.

This one is pretty straightforward. If your patient’s insurance coverage or insurer isn’t correct, that claim will result in an immediate denial. Completing that claim requires reaching back out to your patient for their insurance coverage details because, again, we only talk to payers, not your patients. You are better placed for direct patient interactions.

Here's how to get your claims paid promptly:

Reconnecting with a patient creates extra work for you or your team, and it can be tedious work, too. Before every patient’s treatment, ask them if they’ve changed insurance, changed their job or their marital status, or if they’ve moved.

With any of those major changes, it is more than likely their coverage has also changed, and the patient just doesn’t know that it’s important to inform you about it. They’ll need you to ask so that you can verify the details and create a claim using their current payer information. Once that’s in place, we’ll carry the claim from there.

Reason #5. Provider credentialing problems 

Credentialing is a point of frustration for most dental professionals because of how painful it can be. Approval can take a long time, and teams are left in limbo if re-credentialing isn’t resolved before the deadline. Alongside many other things, current credentialing is crucial for compliant dental insurance claims.

Why it matters: Insurance carriers will only process claims for a provider who is properly credentialed, aka in-network

This one is also pretty straightforward, but misunderstanding can lead to fraudulent claims, so here’s the gist: to be considered an in-network dentist for that payer, the dentist must be credentialed with them to submit valid insurance claims for reimbursement. If the dentist isn’t properly credentialed for the submitted claim, it will face an immediate denial.

Here's how to get your claims paid promptly:

Start the credentialing process as soon as a new provider joins the practice or well before their renewal deadline.

Bonus: 7 ways to create seamless credentialing: 

• To minimize maintenance, enroll with only 4 or 5 of the most popular insurance providers in your area.
• When it’s time for fee negotiations, ask the insurance company for what you want—they may agree to it.
• Contact or research local dental practices and ask which insurers they are in-network with.
• For a new practice, start the credentialing process in the first steps of building your dental business.
• For a new dentist to an existing practice, start the credentialing process as soon as they join.
• Always file claims with accurate provider information to avoid claim denials and fraud accusations.
• Use DCS automated credentialing services to take this problem off your plate.

The DCS Credentialing service is more than just delegating an unwanted project. You’ll also gain access to an up-to-the-moment view of your application status on an uncluttered, easy-to-use dashboard that’s available 24/7.

Traditional credentialing, on the other hand, leaves you in the dark for the entire process—up to 3 months or more!

Read more: Top 5 mistakes dentists make in the dental credentialing process

Reason #6. Paper charts instead of digital charts

DCS requires digital charts for dental claim submissions. Since our claims specialists remotely access your practice management software to manage your insurance claims, they have no means to attach tangible documents to your digital claim.

Why it matters: Digital charting makes it possible for remote billers to include documentation needed for claims.

For DCS billing specialists to accurately submit a complete insurance claim for prompt payment, our team will need all the evidence your team can provide for why a treatment was necessary—as with all attachments, the more the merrier.

Here's how to get your claims paid promptly:

Transition to digital records to streamline documentation retrieval for our remote team—and also for your in-office team. We understand adapting to technology can be a challenge, but it will fast-track your entire system when everything is digital. You’ll reduce costs and paper waste, too. It’s a win-win.

Reason #7. Data entry errors

Data entry errors happen to everyone. Unfortunately, when data entry errors aren’t caught before an insurance claim is submitted, they lead to denials and appeals, and therefore, payment delays.

Why it matters: Insurance carriers require accurate patient information to match their payer records and reimburse your claim.

Our team submits, monitors, and manages the dental insurance claims created by your team. This means all the information provided on the claim needs to be accurate before we receive it. Our billing specialists will catch obvious errors, but typos such as reversed digits in a birthdate or payer ID aren’t apparent and will result in a claim denial. Either way, they will reach out to your office for accurate information and then appeal the claim, but this stalls the claim reimbursement process. It's better to have all the patient and treatment information correct the first time.

Here's how to get your claims paid promptly:

Insurance verification is key to current information on an insurance claim, but it’s only effective if those details have been entered accurately. When patient, payer, and treatment information are entered correctly at the start, your team sets the stage for streamlined reimbursement and quicker collections.

BONUS: How to make the most of insurance verification:

• Verify patient insurance prior to the day of their treatment (2 or 3 days)
• Verify the patient’s insurance coverage again when they come in for treatment
• Ask patients if there has been a job change or life change that affected their coverage.
• Triple-check group ID numbers, birthdates, and other numbers
• Use DCS Insurance Verification services, and our specialists do all of this for your practice.

Related: Dental insurance verification: The domino that knocks down your entire revenue cycle

Reason #8. Image or document attachments are missing or inaccurate 

Attachments and documentation are essential for claim acceptance. When these pieces of information are missing from your claim, we’ll reach out to your team to complete the claim.

Why it matters: Insurance companies require illustrative attachments (x-rays, perio charting, intraoral photos) to justify or prove the procedure.

Insurance companies will only cover treatment if they have proof that it was necessary. Without visual confirmation, the claim will be denied, causing a delay in payment.

And unlike data entry, we can’t simply re-enter data—if the treatment was properly documented at the time, you won’t have anything to resubmit with the claim.

Here's how to get your claims paid promptly:

Thoroughly document treatment—more than you think you need to. It not only helps with claims, it can also help you educate patients or even be useful if legal problems arise. 

Our teams rely on your team to have photos, x-rays, narratives, and any other attachments properly collected and recorded to include with your claims. Developing and following standard operating procedures for documentation is a proven way to ensure your claims are submitted with everything they need for prompt payment.

Reason #9. Claim was filed after the timely filing deadline

When claims are filed soon after treatment, that allows plenty of time to resolve any issues that may arise before the timely filing deadline. The sooner you create claims, the sooner we can submit them—and the sooner you’ll be reimbursed.

Why it matters: Initial claim submissions must occur before the timely filing deadline, often within 3 to 6 months.

Many insurance carriers require claims to be submitted within 90 to 180 days of the office visit. Claims denied because they were submitted after timely filing deadlines can rarely be appealed. This is probably the simplest reason on this list that claims go uncollected.

Here's how to get your claims paid promptly:

Create claims within 24-48 hours of treatment. This way, we’re getting started immediately on the submission process and have plenty of time to make corrections or adjustments or to appeal the rare denial. This also ensures the treatment and patient’s information is top of mind, so creating the claim feels less strenuous. 

Reason #10. Your team isn’t communicating with our team

Working with DCS on insurance billing is a true partnership—our support for your claims management requires your support. After your team creates insurance claims, we will submit them and follow up until they’re paid, including the occasional appeal. If we encounter one of the 9 issues listed above, we will need information that only your team can provide before we can submit the claim. 

Why it matters: Your office is the only source for the vital information needed to file a clean claim, so it’s important that your team replies to our calls and emails.

When our team reaches out to yours, it’s most likely for additional information required for  reimbursement. The longer it takes your team to supply ours with requested additions or corrections, the longer it will take for payments to arrive.

Here's how to get your claims paid promptly:

We know inboxes get busy, but as an extension of your dental team, try to respond to our specialists and managers within 24 hours or so, as you would any valued co-worker. When you prioritize responding to our outreach, we can submit claims faster and get you paid sooner.

Read more: What is it like to work with DCS? 6 questions answered

Let’s work together to get your claims paid

To recap, here are 10 reasons why your dental insurance claims will be slowed for payment: 

• Reason #1. Clinical notes are missing or incomplete
• Reason #2. Case narrative lacks details
• Reason #3. Patients are unaware of Coordination of Benefits rules
• Reason #4. Insurance policy or plan changes due to a new job, a lost job, or other life change
• Reason #5. Provider credentialing problems 
• Reason #6. Paper charts instead of digital charts
• Reason #7. Data entry errors
• Reason #8. Image or document attachments are missing or inaccurate 
• Reason #9. Claim was filed after the timely filing deadline
• Reason #10. Your team isn’t communicating with our team

Our partnership with your office is exactly that—a productive and profitable collaboration. While DCS handles the middle and end of your insurance billing revenue cycle, your front desk team is essential for giving each claim a strong start and providing the information only they can access.

We’re here to support your team, not to replace them. With clear communication and accurate documentation, we can help you maximize collections and minimize delays. Let’s get you paid—promptly: Book a free 30-minute consultation with DCS today.