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!

Negative Reviews: How do Dentists Feel About it?

We have been reading everywhere about how a contract stifling negative reviews has gone terribly wrong for a New York dental practice, and decided to ask our clients to weigh in.

A Manhattan dentist asked would-be patients to sign a contract before receiving services.  The “Mutual Agreement to Remain Privacy” form sought to prevent patients from criticizing the dentist on review sites, Internet blogs, or online forums.  Moreover, a copyright clause in the form assigned the dentist as the owner of any such comments so that she can have them removed in the event they appeared.

The patient alleges that he was required to pay the practice $4,800 up front to treat his sore tooth in 2010, and she would submit paperwork to his insurance for reimbursement.  Sounds pretty simple!  However, the patient says that the doctor’s office never submitted the claims to his insurance, nor would they provide him with necessary paperwork to submit the claims on their own (seems she didn’t use DentalXChange for electronic claims!).

This prompted the patient to take to Yelp! and other online websites and write a negative review about the doctor, which she saw as a breach of contract.  She subsequently tried to fine the patient for the negative remarks, to which he counter-sued.  In a twist of irony, the story has caught fire among media outlets and bloggers and tarnished the reputation of the dentist.  You can read more about this on Forbes.com.

We’d like to know how you feel about reviews on online websites.   How do reviews affect your practice?  As a dentist, do you think they help you more or hurt you more?