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How to win dental insurance appeals with RCM on your side: 5 simple tips

October 12th, 2023 | 7 min. read

How to win dental insurance appeals with RCM on your side: 5 simple tips Blog Feature

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Your insurance claims account for nearly half of your overall revenue. It’s crucial that you collect all that you can from each and every insurance claim for your dental business to survive and thrive. 

If this is the case, why is it so difficult to get claim reimbursement upon first submission?

Filing insurance claims feels like you’re playing a losing game, and the losses keep stacking up — just check your AR aging report. When claims are consistently denied, you’re missing a huge chunk of your income. Why does dental insurance do this?

According to Dentistry IQ:

“One of the most common ways insurance companies ensure that their profits soar is to collect monthly premiums from their members (our patients), then deny as many claims as possible by referring to the literature in a patient’s contract, specifically the exclusions, limitations, or frequency provisions.

Exercising their right to deny payment of claims based on this literature ultimately results in decreased payouts and increased profits for the insurance company.” 

This explains why your office team has to go through the appeals process more often than you’d like. A significant portion of your business revenue depends on it, however, so there is no other choice if you want to get paid.

But the appeals process is challenging and time-consuming. Members of your office team could be stuck on the phone with an insurance company for an hour — per claim — and unable to complete other tasks. 

A wise business move is to let revenue cycle management (RCM) experts manage your claims submission and appeals process, so your team can avoid it altogether. RCM experts can handle the process for your dental business, giving your team more time to focus on their #1 priority — running your dental practice and caring for patients.

But nonetheless, we’re sharing our top 5 tips to win insurance appeals, including a bonus tip at the end. 

First thing’s first: 

Why would you need to send a dental appeal?

As you know, an appeal is a request for reconsideration and reprocessing of a claim that has been processed and denied by the insurance company.

Denied claims lead to dips in revenue, an increased administrative workload, and can even affect your patient's experience at your practice. All these side effects of denied claims are damaging to your dental business — more proof that appeals are vital for your continued success.

Related: 10 reasons your dental insurance claims are being denied

A dental claim should be appealed when insurance denies a claim that you feel should have been paid, or if a plan paid less than you feel it should have.

A few common reasons an appeal would be submitted are:

  • Timely filing
  • Downgrades
  • Alternate benefits
  • Medical necessity
  • Any incorrect denials

Appeals are annoying but inevitable. Insurance companies are the biggest buildings in any city you visit. Why? Because they deny claims!

Knowing how to win insurance appeals will save your patients money and put insurance dollars in your bank where they belong.

Being the smart person you are, you know when a procedure should have been covered by insurance but wasn’t. However, your team may not know the best way to overturn the decision.

Here are the top 5 tips that our RCM experts suggest…

Tip #1: Give the insurance company all the information on hand for the denied claim

To avoid the need for appeals, give the insurance company as much info as possible with the initial claim submission. This will cut down on denials.

However, a claim may still be denied due to lack of evidence. There are times when an X-ray and narrative aren’t enough — X-rays can’t see what the naked eye can. Use detailed narratives and intraoral photos to supply as much evidence as possible for why the procedure was necessary.

Related: Why attachments are important in dental insurance claims

Tip #2: Have a list of appeal requirements for each insurance company

Every insurance company is a bit different regarding their appeals process. This, of course, is another way they make appeals more difficult for your team to follow through with.

For example, some insurance companies want a new claim with additional information, while some want the original Explanation of Benefits (EOB) accompanied by additional information. 

Some want the new claim or the original EOB, or both, sent to an address different from where initial claims are sent; and yet others only accept appeals through their web portal.

Gathering and cataloging the submission requirements for each insurance company will shorten the time needed to submit appeals.

   Need more income? Schedule a call →  

Tip #3: Have appeal templates ready for submission

Many of the same procedures will be denied or downgraded regardless of how well-documented the claim is. Have an appeal template ready and on deck for each of these procedures to save time and be efficient. 

Switching out a patient’s name and claim number and providing additional patient-specific information is easy when a template is already in place.

Tip #4: Don't accept “No” for an answer

The majority of office teams don’t follow through on claim research; they accept from insurance every denial they are given.

This is unfortunate, as most of the time, the first appeal will overturn the original decision, and benefits, or in some cases additional benefits, will be paid out right away.

When reviewing denials, no pays, and your insurance aging report, if you don’t agree with the decision, appeal it!

Do not let insurance companies dictate your dentistry.

Tip #5: Make sure you have your patients’ best interests at heart

For patient retention, as well as your own professionalism and image, it’s always best to collect as much as possible from insurance and leave as much as possible in your patient’s pocket — without hurting your own. 

Patients recognize when an office or dental billing company is fighting for them and keeping their best interests at heart.

Related: How to attract new patients to your dental practice or group: 3 tips to help you create an amazing patient experience

⭐ Bonus Tip: The easiest way to win dental insurance claim appeals

These 5 tips are great tools for winning insurance claim appeals, but they don’t eliminate the time and effort it takes to contact the insurance company and actually get it done. 

This time spent on insurance claim appeals takes your team away from your sole source of revenue: Your patients. 

It’s so easy for your team to get bogged down and overwhelmed with monotonous but necessary claims work, especially appeals.

So here’s our bonus tip to you: Hand insurance claims appeals over to RCM experts, so your team can focus on what they do best — caring for your patients and running the dental office.

Related: More freedom with RCM services: 5 ways your dental team will invest their time

When you have experts handling claims, you know they’re being submitted accurately and appealed quickly. Our RCM experts at DCS, for example, know all the best practices and strategies for insurance claims appeals, including specific strategies for each insurance company. They even manage to appeal multiple claims in a single phone call. 

Not to mention, they have unlimited access to our DCS Knowledge Network.

We have over 100 employees who specialize in dental insurance. If your designated RCM expert is having doubts about an appeal, there is a massive pool of expert colleagues they will turn to for answers. 

Either way: Your claim is going to be appealed, and your practice will get paid. 

And your team will finally have time to spend on growing your practice and creating relationships with patients, instead of fighting on the phone with insurance companies.

How to win the dental insurance claims appeal game every time

To recap, here are the 5 tips we’ve shared to win insurance claim appeals: 

Tip #1: Give the insurance company all the information you have for the denied claim

Tip #2: Have a list of appeal requirements for each insurance company

Tip #3: Have appeal templates ready for submission

Tip #4: Don't accept “No” for an answer

Tip #5: Make sure you have your patients' best interests at heart

⭐ Bonus Tip: The easiest way to win dental insurance claim appeals is to bring in RCM experts

When seasoned experts handle your insurance claims, there will be fewer errors in your processes, and your team won’t be stuck on the phone for hours with insurance representatives.

You’ll see fewer denials, successful appeals will roll in, and your insurance aging report will go down. All the while, your patients and your office will get more attention from your team, and your collections will skyrocket. 

DCS specializes in insurance claims management services as part of our suite of RCM service offerings. Our experts will confidently collect everything you’re owed. 

Leave the tedious claims work to the experts at DCS while your team focuses on your patients: Schedule a call today.

See your dental business thrive with cash flow you can count on


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