Monthly Archives: October 2015

Why Are My Dental Insurance Claims Rejected?

The hours wasted into investigating why an insurance claim gets rejected can drive a person crazy and waste many quality hours that could be spent with patients.rejected dental claims

To help alleviate the aggravation, we talked to Lindsey Schurman, Manager of Client Services at DentalXChange, to find out how you can avoid being placed in a straightjacket and get those important claims paid quickly.

What are the top reasons claims are rejected? 

The three issues we see most often are:

  1. The provider’s information does not match what is on file with the payer
  2. The patient info does not match what is on file with the payer
  3. The patient is no longer covered under policy

How can these be avoided? 

The best way to avoid a rejected claim is to check the patient’s eligibility when they first make an appointment. This is easily done through ClaimConnect’s Real Time Eligibility. After eligibility is checked, make sure the patient’s ID card matches what is in their chart. This will help avoid discrepancies between information on file and what the payer has on record. After a client receives rejection, the advice we share is to verify that all the information matches what is on file with the payer.

When DentalXChange investigates a rejected claim we ask the following questions:

May I please confirm the patient info to make sure we have matching claims info?

Asked the payer to confirm:

  1. The Patient and Subscriber Name
  2. Dates of Birth
  3. Member IDs
  4. Addresses
  5. Genders
  6. Group/Plan numbers
  7. Plan Effective Date

May I also confirm that the correct Provider information listed on the claim is on file?

Ask them to confirm:

  1. Rendering and Billing
  2. Name
  3. NPI
  4. TIN
  5. Address
  6. License number
  7. Any applicable provider ID or Taxonomy code

One of these issues is usually the reason a claim gets rejected.

How does a product like ClaimConnect help?

When submitting a claim through ClaimConnect, the program focuses on minimizing rejections by checking claims for the preventable errors. We call these validation errors. Validation errors prevent claims from being sent when the information does not match what the payer requires. They can range from incorrect procedural codes to incomplete provider information. These errors are flagged and allow you to fix any discrepancies before the claim is submitted to the payer.

This saves a ton of time dealing with rejected claims. Of course, if anyone is having an issue with claims rejections, they can always give us a call. Our customer service representatives will be happy to help resolve any issues you might be having.

Thanks for taking the time to help us, Lindsey!

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Filed under ClaimConnect, dentalxchange, EDI Claims