We understand that being an office manager has its many challenges–handling the office’s finances, patient appointments, making the doctor happy, submitting claims…. we get you! It’s easy to make a mistake every now and then–especially when submitting claims. We here at DentalXChange know it’s not uncommon to accidentally type in the incorrect procedure code, select the wrong surface or name the incorrect quadrant. Or oops! That patient is actually insured by Aetna but you accidentally put MetLife as the insurer. It’s estimated that this results in an added $1.5 billion annually in added administrative costs in medical offices, and we are pretty sure it results in the same amount of loss in your dental practices. So how do you improve claim acceptance?
Paper Claim Process
First, you have to understand the difference between a paper claim and electronic claim. A paper claim takes longer to process because oftentimes, a real-life person is reviewing the details of the claim. If they find an error with the claim, it’s mailed back to the office to fix the error, sent back to the insurance company and it goes through the review process once again! This process takes much longer (an average turnaround time of 45 days!) so it’s not surprising that it adds to the cost of administrative work. (Think: extra hours at work, paper costs, stamps…)
Electronic Claims Process
Electronic claims, on the other hand, are reviewed electronically by a computer. The claim values are read and matched up to the patient’s file. It’s a much quicker process and rejections are turned around more quickly. But if you still want to avoid all those rejections, DentalXChange can help you!
Our state of the art claim validation system takes less than 5 minutes to scan your claims and find invalid information. DentalXChange thoroughly checks your claim codes and matches them to your teeth numbers. If there are any issues with the claims, we mark them for errors and let you know almost immediately via your Activity Snapshot. Simple as that! We make it easy for your offices to fix the errors right away by going back to ClaimConnect to fix those errors instantly online.
Five Tips to Improve Claim Acceptance:
1) Double-check the patients’ subscriber ID or Social Security Number when taking their insurance information
2) Always grab the Group Number– some insurance companies, like United Health Care, require the group number be submitted with electronic claims
3) Make sure you spell the patient’s name exactly as it is on the card — If it says “Jonathon Patient”, make sure you don’t write “Johnny Patient” or “John Patient” on the claim. Some insurance companies are particular about this.
4) Match the procedure codes to the tooth numbers. Anterior codes are different than posterior codes – we see this error very often!
5) Sign up for an X-Ray/electronic attachment validation system like our NEA FastAttach Integration. It will save you the guess work! Get an alert in as little as 10 minutes if a claim requires an attachment instead of having to wait for the insurance company to request an X-Ray, mail it, and wait for the claim to be processed.
DentalXChange’s claim validation process checks for all of these items on your ADA 2006 dental claims forms, but it’s always a good idea to know what helps your claim’s get accepted more quickly!
Let us know if you have any tips to improve your claim acceptance!