Claims Recovery

Receiving insurance payments in a timely fashion allows the dental office to make ends meet. It becomes difficult to pay business bills–including payroll–when there are a lot of unpaid dental claims. And you want to get paid, don’t you?

We recommend running an outstanding insurance report every Monday. As time permits throughout the week, the front desk should use that report to contact the insurance companies for any claim overdue by 30 days or more. (Most insurance companies will not entertain claim status questions unless the claim is overdue by at least 30 days.)

It’s very easy to do this. Simply call the insurance company, provide them with the patient information and claim date of service, and ask about the status of the claim.

  • Dental Claim Attachment Needs by Category
    Dental Claim Attachment Needs by Category

    Insurance companies often require additional documentation for certain procedures to process claims. Here's a list to help you know when that additional documentation is needed.

  • There are many reasons why insurance companies are slow to process claims. Here are the three biggest reasons.

  • 1

    The claim was never received.

    Send it to the insurance company again. Sometimes it helps to send it in multiple ways to ensure they will receive it. Send it electronically, via fax, and send it in the mail. Document your submissions.

  • 2

    There is missing procedure information.

    Payment to the office will be greatly delayed if information is missing from the claims. Some procedures require certain information added to claims.
    Here are some examples:
    Orthodontic claims require diagnosis, treatment length, and total treatment fee.
    Crown claims require a pre-op x-ray, seat date, and date of original placement, if it is a replacement crown.
    Endodontic claims require a post-op x-ray.
    Scaling and Root Planing claims require periodontal charting, x-rays, and sometimes a narrative.
    Be sure to add any additional information the insurance company requires and resubmit the claim. Send it in multiple ways.

  • 3

    Incorrect subscriber information

    This is a common problem for offices that are not verifying dental benefits ahead of time. Claims should not be sent to the wrong insurance company or with the incorrect subscriber info if the front desk updates patient contact and insurance info as patients come in for appointments.

  • The biggest lesson here is to make sure claims are sent correctly, the first time, to avoid payment delay.
    We’ve included an example of a Weekly Claims Status Recovery report for you to download. It’s helpful for a manager to receive the status of overdue claims in that report. Be sure to document any claim status notes in the patient’s file in the practice management program.

Have way too many outstanding claims and need help getting them under control?

Contact Mary Beth and Dental Support Specialties.
Insurance claims recovery is one of the many services she offers! or call 330-639-1333