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. In order for a claim to be sent correctly electronically, there are certain steps and details that must be performed. Today, I will give you my easy steps to make sure that your claims are getting where they need to each and every day.
7 Steps To Send Clean Claims
1. Check insurance eligibility before the patient comes in
There are many times that a patient’s insurance may change, but they do not let us know when they come in for their dental appointment. When I’m calling on outstanding insurance claims, I cannot tell you the amount of times that they are overdue because of insurance terminations. Doing this step is an easy way to get in front of these aging claims and catch would-be denials even before the patient steps foot in the office. Dental softwares and insurance log-ins have made it easier than ever to check a patient’s eligibility. For my free insurance login EXCEL sheet template, click here.
2. Have all the patient’s information correct in your dental software
There are key pieces of information that you need from a patient in order to send their insurance claims off. Make sure you have a form for the patient to fill out that has their name, address, DOB, ID or social of the subscriber. In case you miss getting this information on the first phone call, you can always refer back to this form to make sure you have all their information needed to get paid by their 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 of the insurance information correct in your dental software
Speaking of details, also make sure you have the correct name, address, group name, group number, and payor ID for the insurance company. I’ve seen countless claims rejected due to no insurance address or the wrong payor ID attached. Take the extra step to double check that all this information is filled out in your software.
4. Taking diagnostic x-rays pre-op and post-op, as well as IO photos
One of the greatest tools you have in your office to get paid by insurance companies is your x-ray machine and an intraoral camera. If you do not currently take intraoral photos, I highly recommend it. Not only is it the greatest treatment acceptance tool, but it is also vital to combat insurance denials. Take the extra seconds to double check your x-rays and make sure they are diagnostic in quality.
5. Adding 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, IO photos, narrative, initial or replacement
Bridges/Implants- x-rays (include full-arch), narrative, initial or replacement, missing teeth
Endo- x-rays and narrative
SRP- perio chart, FMS x-rays
Guards- upper/lower and narrative
TEs- x-rays and narrative
Palliative Tx- narrative with tooth number/arch
6. Checking rejections daily
Directly after sending your claims, you should be checking your rejected claims. 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 ASAP. Doing a little bit every day helps keep your workload down in the long run.
7. Running 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 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 titled, “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 then ledger.
The third report is titled, “Secondary claims not created.” This report will help you find those secondary claims that were not created after primary pays. You can have it set up in your system for these to automatically be created 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 then ledger.
The last report is titled, “Insurance Claims to Process Report.” This report will help you locate any claims that you did create but for whatever reason, never sent off to the insurance company. Generate this report at least monthly for your practice. This report can be found in the office manager and then ledger.
If you need any assistance locating any of these reports for your dental software, please reach out to me and I would love to help you at firstname.lastname@example.org
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