Quick Claim Payments

The following are some suggestions to speed up claim payments.

Anticipate Questions Related to Policy

Dental consultants look for reasons to approve your claims. Anticipate what questions a dental consultant may have regarding a particular claim and provide the reason it should be paid.

Example: If you replace a crown that is less than five years old, anticipate the obvious question and explain what event or circumstance made the replacement necessary.

Dental consultants are licensed dentists, who share your depth of knowledge about dental treatment and disease. Your knowledge and expertise about dentistry will likely come across clearly if you remember that your audience is a dentist just like you.

Include All Patient Information on Claims

Lack of sufficient information, especially the enrollee’s ID number, is the most common reason for a delayed or denied claim. With electronic claims submission, your claims are automatically edited for missing or invalid information before they are sent to carriers.

Help the Dental Consultant Review Your Claim

For extensive or unusual services, what would you need to understand why a patient needs a particular treatment? Dental consultants cannot directly observe a patient’s condition, so let them know what cannot be seen on an x-ray and any special circumstances unique to your claim.

Example: If you submit a claim for a crown that was placed to restore a tooth with a fractured cusp, be sure the fractured cusp is visible in the x-ray copy. If it is not, include a written narrative so that the dental consultant will understand the purpose of the crown.

Understand the Difference Between What is Covered and What is Needed

Some procedures are not covered under your patient's plan, no matter what documentation is submitted. In such cases, it’s important to understand that a recommended treatment may be perfectly appropriate. It’s just not a payable claim under the terms of the dental benefit contract.

Example: If you provide treatment for erosion, there’s a good chance the claim cannot be paid because erosion is a common exclusion under most dental plans. The same principle applies to treatments that address cosmetic needs rather than dental disease.