For years, managing dental insurance claims has been a mixed experience. Sometimes, claims are approved on the first try; other times, they face rejection, denial, or lengthy appeals before payment is finally received. Recently, a troubling trend has emerged among dental office managers: an increase in claim rejections for unclear reasons.
Conversations with colleagues and industry experts reveal that dental insurance companies are now using artificial intelligence (AI) to streamline the claims process. While AI can enhance efficiency, it also introduces new challenges. In the high-stakes world of dental insurance payments, precision is critical.
Dental office managers must now be more vigilant than ever in submitting claims. Insurance companies have always sought reasons to deny payments, and AI technology may provide them with additional means to hold onto premiums and delay reimbursements.
Several companies have introduced AI-powered “second opinion” software to assist in diagnosing issues by highlighting concerns on x-rays, such as caries, calculus, and bone levels. These tools are designed to aid dental professionals but can also contribute to claim disputes.
Five Essential Tips for Dental Office Managers
Always Provide Comprehensive Documentation Dental claims are frequently denied due to insufficient documentation. To avoid this, include pre-op and post-op x-rays for most basic and major procedures. Detailed documentation and clear identification of issues help justify the treatment provided.
Ensure Clarity in Treatment Justification Clearly define the reasons for treatment. While CDT descriptors outline procedure codes, they do not explain the treatment’s necessity. It is crucial to include a well-written narrative detailing the rationale for treatment and its anticipated outcomes.
Submit Claims Promptly Most dental insurance plans allow a one-year period for filing or refiling claims. However, some plans, especially those from unions or self-insured groups, may have shorter deadlines of 30, 60, or 90 days. Submit claims within these timeframes and follow up on unpaid claims to avoid missing deadlines.
Maintain Accurate Documentation Accurate patient records are vital. Small details, such as the duration of a procedure, anesthesia use, or materials employed, must be documented meticulously. AI systems rely on these details for processing claims effectively.
Use Correct Coding Dental codes are updated annually. Stay current with new and revised codes to ensure accuracy. Ensure that your practice management software, such as Archy, is up-to-date to reflect the latest coding standards.
As AI continues to play a larger role in dental practice management, it is essential to adapt while maintaining a strong team. Claims should be reviewed by knowledgeable staff who understand both the procedures and the rationale behind them. By providing clear explanations and accurate documentation, dental offices can better navigate the complexities of AI-driven claims processing and ensure timely payments.