Tips to minimize the claim denial - Dental claim

Tips for minimizing claim denials or delays for SRP:

– Check the carriers’ guidelines on their Web site or in the provider office reference guide.
 
– When submitting SRP for more than 2 quadrants within a single visit, include documentation—full-mouth periodontal charting, FMX, periodontal diagnosis and the treatment plan.

Tips for minimizing claim denials for periodontal maintenance:
 
– If there are unusual circumstances that require a different interval of treatment than the one specified in the patient's plan documents, the dentist should provide documentation with the original claim submission.
 
– If a patient is covered under a new group policy, submission of the patient's history of treatment with the initial claim for D4910 will assist in the determination of benefits for the patient

Tip to minimize claim denials for core buildup:

– In the initial claim submission, documentation of the condition that resulted in the buildup should be provided, if applicable.

Tips to minimize claim denials and promote patient understanding of benefits:

– Encourage patients to contact their payer directly through customer service lines to verify benefits for particular procedures.
– Submit predeterminations on complex, costly procedures close to the date of proposed service.

Avoid Issues with Bundling and “Downcoding”

Verify procedure codes are appropriately reported in accordance with the current CDT descriptors and nomenclature.
Contact payers directly for clarification of concerns related to coding of dental services.
Explain to the patient in advance of treatment by use of pretreatment estimates that a treatment plan should be decided by what the doctor and patient determine is clinically appropriate, not by plan compensation.


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