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Dental Claims: How to Bill Dental Claims

Filing dental claims can be somewhat unique to filing other kinds of medical claims, but it’s important that dental practices file these claims for their patients in order to remain competitive. We are going to help you to learn what you’ll need to do to file these dental claims so that your practice can get paid and your patients can get the help that they need.

Record and Maintain Patient Information

Dental Claims Apex EDI

You will need a fair amount of patient information when formulating a dental claim. Ensure you have accurate information from the start by asking the patient for this information as soon as they make the appointment. Make sure that you are asking the patient about changes to their information at consecutive appointments so that you never have to deal with a denial due to incorrect patient information.

One way to ensure patient information is collected correctly and in a timely fashion is to collect patient information over the phone at the time the appointment is made. Create forms or spreadsheets that help track the information and remind the person collecting it what data is required. Alternatively, a form can be made for the patient to fill out prior to the appointment once they arrive at the office.

What You’ll Need

You’ll need to collect the following pieces of information:

  • Patient’s name
  • Policy holder’s name and social security number
  • Name, address and phone number of the insurance company
  • The policy number

If the insurance is through the policy holder’s work, you’ll need the employer’s name and address as well.

Determine a Billing Process and Draft an Agreement

It’s important to establish policies for filing dental claims from the beginning, and keep these consistent throughout your practice. Determine how many times you will bill insurance, or how long you will wait before sending a bill to the patient for unpaid amounts.

Once you have determined your billing policies, you’ll need to draft an agreement informing your patients of these policies. This should be signed by the patient before any services are administered, and should be retained in the patient’s record. Be sure to inform patients that they will be held responsible for any unpaid medical bills.  

Ensure Claims are Filed Accurately (or Let Us Do It for You)

It’s important that claims are filed accurately so that your practice can get paid in a timely manner. But navigating the complexity of claims can require more time, money, and manpower than is feasible for many dental practices. Simplify the process by hiring Apex EDI, a clearinghouse that provides you with the tools and assistance you need to save time, cut down on claim denials, and run your billing department efficiently. See how Apex EDI can benefit you and your patients by requesting a demo today.

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Dental Claims: A Typical Visit to the Dentist

Routine dental checkups are essential to maintaining the health of your teeth and gums. Most dentists recommend visiting at least twice a year, although sometimes more frequent visits are in order depending upon your specific needs and health history. If you are anxious about the appointment, here’s what you can expect during a preventative dental checkup.

A dentist, with the assistance of a hygienist, will evaluate the overall health of your teeth and gums. They will look for signs of tooth decay, gum and bone disease. They will also check for calcium deposits on your teeth, stains, sensitivity, discoloration and tartar build up.

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If you have fillings, wear dentures or braces, they may check for wear and proper fit. You will discuss adjustments, proper cleaning techniques and use of tools such as electric toothbrushes, fluoride, mouthwash or dental floss. A visit might also include counseling about your diet and tobacco use that can affect your oral health.  

 

Dental X-rays also allow the dentist and inside view of your mouth and bone structure. While they aren’t performed on every visit, your dentist may ask you to bite down on a film holder while they capture a variety of images; such as a bitewing for upper and lower crowns, a periapical for the entire tooth, an occlusal image of the upper teeth and lower jaw closure, a cone beam computerized tomography for a 3D view and panoramic view of the entire mouth.

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Finally, your dentist will discuss treatment options and recommend the best time to return for a follow up visit. Apex EDI will make it easy for you to pay for your preventative checkups, dental treatments and follow up exams. We will simplify the billing process and ensure your claim is paid quickly so you receive the best possible dental care.  

Contact us to learn more about Apex EDI!

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

 

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Claims Processing: Dental Claims vs. Medical Claims

dentist
There are some similarities between preparing dental claims and medical claims. For example, patient and insurance demographics and insurance information that must be provided to medical carriers are similar.

However, there are some very significant differences between the two. While dental carriers typically require a procedure code. Medical carriers not only require procedure code(s) but also the reason why the procedure(s) were performed or the patient’s diagnosis.

Diagnoses are classified in code form in the ICD-9-CM “International Classification of Disease, Ninth Revision – Clinical Modification” manual. Without at least one diagnosis code that supports the procedure(s), the medical claim will not be paid. There must be an appropriate diagnosis to establish the medical necessity of the procedure. This is probably the most important part of successful dental-medical cross coding.

Another very significant difference between dental and medical coding systems is the time period and frequency between updates, deletions and revisions. All medical code sets update yearly and medical carriers generally offer no grace periods on using outdated codes.

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The medical claim form also has some major differences compared to the dental claim form. Most medical carriers require the CMS-1500 (08-05) claim form. Medical carriers require these preprinted, red-inked forms because these forms are the only ones that scan correctly. Hand-written claims and comments or copies are not accepted.

Apex EDI can provide the best medical electronic billing for all of your medical claims and dental claims. The main benefit to implementing a dental-medical cross-coding system is satisfied patients who recognize your willingness to help them save their dental plan allowance and access medical benefits. Grateful patients can become your most valuable marketing asset.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

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Dental Claims: What Information is Required for Filing a Dental Claim?

Even though diagnosis and billing codes may vary from patient to patient, a few items are required consistently on each dental claim. We’ll now discuss which items you’ll need to ensure are visible on each claim before submission of payment to the payer.

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What’s Required

The following information is required for filing a dental claim. Each claim that your practice submits to payers needs to include the following:

  1. The Subscriber’s ID;
  2. The Patient’s Name, Date of Birth and relationship to the Subscriber;
  3. The Dentist’s name or Practice Name, Tax Identification Number or Social Security Number, National Provider Identifier (NPI) and phone number;
  4. The American Dental Association procedure code number (CDT), treatment date, tooth number, tooth surface(s), doctor’s fees, and a narrative or description of services as appropriate;
  5. The Member’s signature for release of information and/or assignment of benefits. Signature on file is acceptable;
  6. The Dentist’s signature.

Ensuring Correct Submission

In order to ensure that each claim is correctly filed and submitted to the payer, it is advisable that your dental practice maintain an up to date practice management software. These softwares will allow your staff to enter the necessary data that is required for proper dental claims.

Be sure that the software you use for your dental practice is optimized to include the required data for each patient. For example, you might be able to create forms within your practice management software that allow you to created mandatory or required fields to be filled out before the form can be officially saved to the patient’s chart. Check with your software provider to see if these options are available to you.

In addition to practice management software, it is important that your practice utilize a clearinghouse. A clearinghouse is a software that integrates with your existing practice management software to scrub your dental claims for errors or inaccuracies. The clearinghouse notifies your claims staff of errors within the claims, allowing the claims professional to address and correct the errors before final submission.

If you would like more information regarding dental claim clearinghouse submission, check out our Dental Provider page to learn more.

https://www.benecare.com/dentists_info.asp?a=13&b=2

http://www.apexedi.com/dental-claims/


Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Dental Claims

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Dental Claims: Why You Should Use Dental Billing Software

Smiling woman at dentistAs a dental provider, you wear a lot of hats. Dental claims billing might be one of them. Let’s discuss why it will be beneficial for you and your dental practice to consider using a dental billing software, such as Apex EDI.

Specialized Software

Dental claims codes are completely different from standard medical claims codes. Dental billing software is designed specifically for dental claims billing. Without an efficient software to integrate with your practice management system, you’re risking increased opportunities for errors, missed claims, or denied payments.

Apex EDI dental software integrates with your existing dental practice management software to create properly completed dental claims to be billed to payers. Apex EDI will alert the dental claim preparer of any errors that may be present on the claim to be submitted. Such errors might include a typo, or an absence of other information such as x-rays.

Faster Processing

With the right dental billing software, your practice can get paid more quickly. Traditional dental claims filing through the postal service or through fax or email can take weeks to process. A dental billing software allows claims to be processed in significantly less time.

For example, Apex EDI provides real time information on the claims processing progress. Not only will you be able to view patient eligibility and benefits within minutes, you’ll also be able to process dental claims faster and more efficiently.

Faster processing means faster payment for your dental practice, so you can focus on providing exceptional service to your patients.

Cost Savings

Another benefit of using a dental billing software is the cost savings that is associated with the practice. Dental billing software traumatically cuts down on the physical paper trail of information, as well as postal service and shipping expenses to send claims to the payer.

Apex OneTouch (the desktop app) allows for the seamless integration of your existing dental practice management software with the EDI to provide exceptional cost savings and efficiency for your dental practice.

For more information on Apex EDI for Dental Practices, be sure to check out our Dental Claims page.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Dental Claims

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