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Dental claim appeals: 3 mistakes to avoid

June 22nd, 2022 | 4 min. read

Dental claim appeals: 3 mistakes to avoid Blog Feature

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Handling dental claim appeals can feel like you’re going into battle. All you want is to be paid for what you’ve earned as a dental provider. But constant change makes it hard to keep up with new rules. Updated codes, contracts, terms, and conditions, give dental insurance companies endless new reasons to delay or deny payment for insurance claims. 

Unfortunately, the need for accurate claim appeal processes isn’t going away. Insurance claims can account for 60% or more of your dental practice’s overall revenue. Getting these claims reimbursed properly is vital for cash flow. Unfortunately, a lot of dental teams don’t know how to file successful dental claim appeals that pay.

Dental ClaimSupport is an outsourced dental billing service that has been handling dental practice claim appeals for over 10 years. We are the experienced experts on what claims need for reimbursement and the mistakes that can cost your practice when it comes to appeals.

In this article, we will dive into 3 common mistakes we see when dental teams handle insurance claim appeals. When your team understands these mistakes, they will know what they need to do to avoid them. Appeals are a part of the dental claims process, and handling them properly will put more money in the bank for your practice. 

1. Not taking the time to appeal denied dental insurance claims

You’d be surprised to learn how many dental teams simply don’t file appeals. Maybe they neglect the opportunity because they don’t even realize they have denied claims to appeal. 

It also might mean the dental team doesn’t make appeals a priority - thus getting overwhelmed with a backlog of denials. If either of these sounds like your dental team, it’s time to see this as an urgent problem to fix. When you write off denials that can be overturned, you are literally handing over money you’ve earned to the insurance company. 

Not only does your team need a system in place for working the insurance aging report, and catching denied claims to appeal, but that process needs to happen every day.

Read 10 reasons your dental insurance claims are being denied in our Learning Center.

Appeal oldest denied insurance claims first 

Unfortunately, once an insurance claim is denied, the clock starts. Most insurance companies give the practice a set amount of time to appeal a denied claim. If you don’t submit an appeal within these time restrictions, you can’t expect to get paid. This means you have to write off revenue you could have collected! 

So make sure you know how much time you have to appeal claims. It is different for each insurance company, ranging from 90 days to 1 year. This is why you should always start with the oldest claims - because you want to avoid running out of time to submit an appeal. 

Neglecting your denied claims and hitting timely filing limits are basic mistakes to avoid. Now let’s get to a few finer points.

Gandalf is your guide to insurance aging reports

2. Using a template and not using supportive documents

We get it - appeals require time and many details. Because of this, it can be tempting to use generic templates when submitting claim appeals. These templates were created in the early 90s by many consultants and unfortunately are still pretty common among dental teams.

The problem with templates is that they are typically missing important details, notes, and documentation. Or they have details that do not support the clinic notes. And these details are what prove that the services rendered were necessary to treat the patient. We always recommend that teams “over-explain” themselves when they send appeals (or original claims!).  

The clinical notes must always support the procedure code and narrative. 

When you add as many details as possible - clinical notes, pre-treatment x-rays, intraoral photos, perio charts, and narrative - the insurance company has less reason to deny your claim.

And when you include details in your appeal, you’re likely to be reimbursed properly.

Consider picking up the phone and calling the insurance company about the denial

Sometimes you’ve got to do the old-fashioned thing: Pick up the phone and call the insurance company. 

This might take more time, and you might be put on hold, but it’s a good strategy for winning an appeal. You will be able to speak to a real person (hopefully) and figure out why the claim was denied in the first place. 

When you do this, just make sure you have those detailed documents ready and not a generic, imprecise appeal template. 

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3. Adding incorrect information when sending an appeal

You now know you need to include all of the details and supporting documents showing why you performed services when filing your appeal. But when nitty-gritty details become involved, there’s a greater chance for errors to be made. 

A big mistake we see with the dental team handling appeals is not paying attention to the details of the request and sending the wrong information. There are a lot of numbers involved in claims such as member IDs, dates of birth, fax numbers, addresses, CDT codes, and more. 

It’s easy for these numbers to get mixed up. So be sure your system for appeals includes a step to check for errors and fix them before filing your appeal.  

Ready to learn tips on what your claims need for reimbursement?

You now know what mistakes to avoid when handling insurance claim appeals. Don’t let your backlog of denials buildup, include every supporting document and avoid generic appeal templates, and make sure all of the information on the appeal is correct. 

This will lead to you winning your claim appeals battle with flying colors. 

No time for all this? Filing appeals is part of your Dental ClaimSupport billing service. You’ll see about a 95% win rate from our proven process and up-to-date strategies for dealing with insurance companies - especially denials. 

Not only does your collection rate go up; you save time and overhead. Your fee is based on the amount posted to your account, not the time it takes to overturn denials. 

Now that you know what mistakes to avoid, visit our Learning Center to learn some tips on how to actually WIN dental claims appeals.

Win insurance appeals - see article

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