Dealing with Dental Insurance Consultants

So, that’s the big secret in dealing with dental consultants. Submit clear concise appropriate documentation with your claims and pre-determinations. And if you do, you shouldn’t have trouble with claims being delayed.

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Increased periodontal awareness among patients in general practices

According to a recent article in Dental Products Report, 71% of GP’s report an increased awareness among their patients about periodontal disease with 50% attributing this to education by the dentist and/or office staff. 57% have increased the number of periodontal soft-tissue management procedures in their office with 99% performing pocket probing with a manual probe. Go to dentalproducts.net for the complete article.

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Dealing with Dental Insurance Consultants-Documentation

There are times when the diagnostic quality of the radiograph is questionable. A good rule is to never submit any radiographs that you would not be hesitant to present to your study group.

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Why Your Dental Insurance Claims May Be Denied

Is your patient eligible for benefits?

Many claims are submitted for patients who are not eligible for any payments(their benefits have run out or coverage is terminated). Rather than file a claim or predetermination and wait weeks to find out that they have no coverage you’ll be billing the patient for all costs, check a patient’s eligibility before-hand. Depending on the insurance company you can often check either by phone, using their IVR or even going online.

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Emdeon and the ADA

The ADA and Emdeon (formally WebMD) are teaming up to improve relations with dentists, insurance companies (payers) and demonstrate the data that can be obtained electronically including:

Eligibility
Benefit determination
Claims information
Claims’ status
Electronic remittance
Electronic fund transfer

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FDA approves Decapinol

The FDA recently approved Decapinol as a treatment for gingivitis but as a device, not as a mouth rinse. Other rinses kill the plaque bacteria or interfere with bacterial metabolism while Decapinol forms a physical barrier.

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Are Some Of Your Patients Smokers?

A recent survey indicated that more than half of all smokers visit the dentist regularly. Are you doing your part to identify these patients and educate them as to the risks they are exposing themselves and others around them to?

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Dealing with Dental Insurance Consultants-Documentation

Many companies will require a pathology report before allowing benefits for a biopsy.

And they frown on paying for cystectomies for every 3rd molar that's extracted or apicoectomy

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Dealing with Dental Insurance Consultants

Most insurance companies will need to see recent full arch films for implants and removable/fixed prosthesis to determine if an alternate benefit is appropriate. But some will accept a "toothmap" in lieu of radiographs. To avoid submitting unneccessary documentation, check with a patient's carrier.

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#1 Reason Dental Insurance Claims Are Denied

Did you know that the Number One reason claims are rejected by insurance companies is that the wrong group number is placed on the claim?

If you’re filing electronically, always make sure that all information is accurate in your software.

If you’re using paper claims, be accurate and legible. More insurance companies are using optical scanning (OCR) to input claims into their system and a smudged entry can be mis-read.

Whenever a patient is starting a new series of visits, confirm that their correct insurance information. They might have switched jobs or benefit levels in the interim and your old information might not be accurate.

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Correct CDT coding of dental insurance claims

If you use a code that has been discontinued, that service will usually be denied by most payers. (For example, it has been discontinued, some offices continue to submit the procedure code D4220 – gingival curettage)

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Correct CDT coding of dental insurance claims

A mistake we see is in their haste, some offices will mis-code retainer (abutment) teeth as pontics and visa versa. This can lead to denial of the claims and return to the office for correcte coding. A lot of time can be wasted as a result of this simple avoidable mistake.

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Correct CDT coding of dental insurance claims

Use as specific a code as you can find. If your procedure is not listed, you can use the last code (unspecified procedure, by report) in each grouping, DX999, but include a narrative to explain what you did.

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