Submitting Dental Restorative Claims With Success
Submitting dental restorative claims correctly gets you paid faster! And who doesn’t want that? But often times, we can be in a hurry. Or maybe feel under pressure and want to move on. It’s better to take the time to do it right the first time. Not to receive a request for additional information 30 days later. Or even worse, a denial we must appeal. Perhaps, we receive nothing at all. Then, we are left to call the insurance company to follow-up on the unpaid claim.
Keep it simple. That sounds good. Right! Everyone likes simple. But how do we keep this simple. How do we know when to send an x-ray? And should the x-ray be taken before or after the procedure? What about narratives and photographs? Here’s how to be sure your dental restorative claim doesn’t get denied for additional information!
Standardize Your System!
Standardize your system. Submit the same information with each restorative dental claim. Avoid the dental insurance company asking for additional information. But don’t overload the claim either! Make it short and sweet. Stick to the facts. And customize each claim for every individual patient with your notes. So, you will need great chart notes!
Great photos and x-rays are necessary. Be sure you have the right tooth or teeth with each claim. And try to think like an insurance claim examiner. Look at each claim and x-ray as if you have doubt. Imagine you want to find a way to deny or delay payment on a claim. Then be sure there is no way possible for that to happen. We just have to be smarter and cover every aspect of explanation. Leave no stone unturned. And give the insurance company everything they need with the first claim submission.
Submitting Dental Restorative Claims With Narratives
Many restorative procedure codes require a narrative. A short narrative never hurt anyone! Regardless of the restorative procedure code. When the chart notes are clear, we can be clear. Now, remember, we want to keep it simple. And we only want to write what an x-ray doesn’t show. And what a photo may be unable to clarify. In your narrative, imagine that you can’t read an x-ray. But, be sure to do this with as few words as possible. And the narratives should go in section #35 of your dental claim form.
Do not standardize narratives. This can be a huge red flag to a claims examiner. And your dental practice doesn’t want that kind of attention! Try to fit the information you need on the claim form. But if you can’t make that happen, add an additional page. Just be sure to make a note on the claim form that a narrative is attached on a separate sheet.
Write something about every restorative procedure. It doesn’t take long. And the chart notes you have say clearly why the procedure was done. So take the time to make your claim powerful. Remember, the idea is to leave no room for question. Even though it may take a few seconds longer now, it will get you paid faster. And hopefully avoid a denial. Or the time it takes someone to call on the claim. Do it right the first time!
Submitting Dental Restorative Claims By Procedure
Basic Restorative
Composite restorations (3 or 4 surfaces): Be sure to include information about any existing restorations prior to today’s procedure. Include the surfaces previously treated. And also the age of the existing restoration. Even if you need to estimate this. And then the reason for a new restoration. (decay, fracture, pain) Then send any bite wings and individual x-rays both prior to treatment and after. Any photos you have that show fracture or decay not evident in an x-ray is great too!
Major Restorative
Crowns: The insurance company will want you state if this is an initial placement or a replacement crown. Even if to you this is quite evident in an x-ray or photo. Spell it out so a blind man can see!! Really! Then include the date of initial placement if this is a replacement crown. And the reason why the crown must be done. (cracked tooth, pain, fracture, etc.). And don’t forget x-rays and photos!! Both pre-operative and post-operative. Let’s not forget the prep date and the seat date of this crown may be needed. Some insurance plans pay on prep date and others on seat. So be sure you know what you need and when to send your claim.
Buildup: This is a separate procedure. Some insurance companies will pay this as a separate code from a crown. Others will not and will include as part of the crown. But it is a separate procedure. And not all crowns require a buildup. In my opinion, it is best to estimate for your patients a buildup with the crown. Then if they don’t need it, they will be happy! But when you bill this to insurance, be absolutely sure you have pre-op and post-op x-rays and photos of the buildup. And be very clear as to the necessity of the buildup. “The existing large old failing restoration has decayed. And has destroyed the supporting tooth structure. The buildup is necessary to restore function by supporting new crown”.
Veneers
Facial veneers are sometimes a covered benefit. Each dental insurance plan and policy vary. But you definitely want to write a narrative to explain why veneers. Again, keep the narrative to the point. And try not to add your professional opinion. Just the facts! For example, if the veneer is needed to correct decay or replace an existing failing restoration, say so. You’ll also want to include photos and x-rays here as well. Both pre-op and post op x-rays and photos are necessary.
Fixed Bridges
Bridges: A fixed bridge includes either an extracted tooth or a missing tooth. Maybe the tooth was missing long before your patient was your patient. This missing or extracted tooth is an in issue the insurance company will explore. And you must provide information on the date of extraction. Or how long that tooth has been missing. Even if there is no missing tooth clause on the policy. If you need to estimate, do your best. But try to get as exact as you can. And again, be sure to include your x-rays and photos – both pre-op and post-op.
Submitting Dental Restorative Claims: Paper vs Electronic
Is it best to submit dental restorative claims electronically? Or is a paper claim best. There is no blanket answer for this. It truly depends on each individual insurance, restoration, and situation. At least, if you want to get paid quickly! And with the first claim submission. It’s important to know what each insurance policy and company prefers. If an insurance company requests all claim submissions without attachments, do so. If another can’t read the x-rays sent electronically, mail the claim.
Some insurance companies will simply process and pay a restorative claim with no additional attachments. No x-rays are necessary. And you don’t necessarily even need a seat date on a major restorative claim. While others want everything you have and more! Some insurance companies do well with electronic claims and attachments. Other carriers do not have the software or advancement to do so. Many times, you learn these things by trial and error. And it’s best to make note of what works best!
Follow-Up On Outstanding Claims
All claims over 30 days are overdue! That’s right!! If you haven’t received a payment or notification of any kind on an insurance claim within 30 days, make a call. And I know just how time consuming this can be. But the idea is to not allow any claims to roll over into the over 90-day category.
If you have any unpaid dental claims over 90 days, you have a problem! With appropriate insurance claim follow-up and management, there will be no unpaid claims over 90 days. This money belongs in your bank account. Not on an insurance aging report!!
