Top 6 Reasons Claims are Rejected

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Your dental practice can’t afford mistakes. The time it takes to fix a rejected claim costs you hours that you could spend elsewhere; not to mention the refiling fee if you are submitting them through your practice management system.

Here are a few other common reasons why your claims might be getting rejected and what steps you can take to fix them before that happens.

ADA Code Validation Failure

This can be as simple as using an invalid procedure code. It could also be the case that you have the correct code, but the insurance company requires a different one to process the claim (for example, D4342 was submitted with a tooth number, but the insurance company wants an oral cavity code instead).

Subscriber Not Found

This issue indicates that the subscriber isn’t on file or that the submitted ID doesn’t match the insurance company’s records. If you find that you’re receiving this error even though you have verified the subscriber ID, make sure the information is matched with the correct insurance company.

Missing or Invalid Subscriber ID

This is the policy holder’s subscriber ID number. If you are having issues with the subscriber’s ID, try inserting their SSN (social security number) in the subscriber ID field and type the subscriber ID in the SSN field.

Missing or Invalid Patient Information

This covers any information regarding the patient. If the patient is not available to verify their details, you can get this information by reaching out to their insurance company or by checking their Explanation of Benefits (EOB).

Incorrect Entity Address

This includes the address for the patient or the subscriber. Always confirm that the address your patient provides matches what their insurance company has on file for them.

Duplicate Claims

These are caused if you submit the same claim through multiple channels (a third party software, mail, practice management system, etc.). Typically, this means that the insurance company accepted the original claim and is only rejecting the duplicate. However, this can potentially lead to interrupted payment for the claim. It is best that your practice sticks to a single method for submitting claims like Remote Lite(R) e-claims services in the Practice Core solution by Vyne Dental.

Contact a team member today to assess your claim submission process and see where you can improve your workflow.

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