Are dental insurance claim denials costing you time, and money?
Claim denials are one of the most frustrating obstacles dental practices face. They delay cash flow, create extra administrative work, and add unnecessary stress to already busy teams. But here’s the good news: most of these denials are entirely preventable. With the right approach and strategies in place, you can significantly reduce the number of denials and streamline your revenue cycle. This guide will walk you through the five most common causes of claim denials and offer proven methods to prevent them from happening in the first place.
Table of Contents
- Five common reasons for claim denials & how to avoid them
- Pro tips: Long term denial prevention strategy
- The impact of eliminating claim denials
Five common reasons for claim denials & how to avoid them
1. Missing or incomplete documentation
Insurance companies often deny claims due to missing documentation, such as diagnostic X-rays, narratives, or intraoral photos. Without the required proof of necessity, claims are flagged for additional information or outright rejected.
Tips for prevention:
- Create an attachment checklist. Not sure where to start? Download Wisdom's dental billing cheat sheets for dental billing checklists and templates.
- Cross-train your team. Ensure both clinical and administrative staff know the documentation requirements for common procedures.
- Pause before sending. Make it a habit to double-check claims for all required attachments before submitting.
2. Incorrect patient or insurance information
Claims with even minor errors in patient or insurance details—like a misspelled name, wrong date of birth, or outdated insurance plan—are often rejected outright.
Tips for prevention:
- Verify information upfront. Always confirm patient details and insurance eligibility before the appointment. Use digital tools to make the process faster and more reliable.
- Scan and store IDs. Keep copies of the patient’s insurance card and driver’s license on file for easy reference.
- Use a garbage in, garbage out mindset. Train staff to prioritize accuracy during data entry—errors caught upfront save hours of follow-up later.
3. Coordination of benefits (COB) issues
Claims involving multiple insurance plans are prone to denials if the primary and secondary insurers aren’t properly coordinated. Confusion about which payer is responsible for what portion can cause significant delays.
Tips for prevention:
- Ask the right questions. At every patient visit, confirm whether they have multiple insurance plans and update their file accordingly.
- Submit to the primary insurer first. Always send claims to the primary plan before submitting to the secondary payer.
- Track coordination details. Use your software to document payer responsibilities to avoid future mistakes.
4. Lack of medical necessity
Many claims are denied because the procedure wasn’t deemed medically necessary—especially for treatments like scaling and root planing, crowns, and buildups.
Tips for prevention:
- Document, document, document. Ensure your clinical notes clearly outline why the procedure was required. Use the SOAP documentation guidelines included in our dental billing cheat sheets ebook.
- Be specific in narratives. Generic phrases like "crown required due to decay" won’t cut it. Provide precise details, such as the location and severity of decay.
- Invest in intra-oral cameras. High-quality photos can help demonstrate necessity more effectively than X-rays alone.
5. Timely filing issues
Every insurance company has a deadline for submitting claims—often between 90 and 180 days from the date of service. Submitting late is one of the easiest ways to guarantee a denial.
Tips for prevention:
- Track filing deadlines. Maintain a list of filing deadlines for each insurer your practice works with.
- Run daily and weekly checks. Use your practice management software to identify claims that haven’t been sent. Address them before deadlines pass.
- Submit electronically. Digital submissions are faster and provide tracking information to confirm receipt.
Pro tips: Long term denial prevention strategy
In addition to addressing the specific causes of denials, here are some additional strategies to reduce your denial rate:
- Monitor rejections daily. Rejected claims often include feedback that can help you avoid future mistakes. Check your clearinghouse daily to resolve rejections quickly.
- Track trends. Review denials monthly to identify recurring issues. Is one payer rejecting more claims? Are specific codes causing problems?
- Hold team reviews. Meet regularly with your clinical and administrative staff to discuss denial patterns and update protocols.
- Stay up to date regarding dental RCM trends. Participate in continuing education events, such as attending or watching recorded webinars. A great example is my presentation "Secrets to Getting Paid Faster: From Mastering Claim Submissions to Winning Appeals" webinar, hosted by Dental Nachos.
The impact of eliminating denials
Preventing claim denials is about more than reducing frustration. It’s about improving your practice’s financial health and giving your team time to focus on patient care. When claims are paid promptly, your cash flow improves, staff stress decreases, and your patients benefit from a smoother experience.
By identifying common pitfalls and implementing preventive measures, you can transform your billing process and keep your practice running smoothly.
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