We’re going back to the basics, with an answer to a common question: “what is a dental insurance claim?” — plus some good-to-know info on how these types of claims work.

In its simplest terms, a dental insurance claim is a request for payment made by a dental practice to an insurance provider. If the claim is approved, the insurance provider will issue funds to the practice for the service provided.

Sounds simple enough, right? Sometimes it is, however there are lots of complexities built into the dental insurance claim and payment process, and they can put a lot of stress on a dental office’s front desk — not to mention their profits. That’s why dental insurance claims processing pros like us exist, to ease the burden and make sure claims get processed as smoothly as possible.

Dental Insurance vs. Medical Insurance

In many ways, dental insurance is quite similar to medical insurance, at least in the general scope of how claims are handled. There are some important distinctions to be aware of though:

  • Dental claims are not covered under medical health insurance
  • Dental insurance maximum yearly benefits are generally much lower than medical benefits
  • Approvals can sometimes be arbitrary, with little regulation or oversight regarding what insurance providers must cover

That being said, dental insurance and medical insurance are similar in two keys ways: patients must usually meet a deductible and they usually have a co-insurance payment (co-pay). But recognizing the distinctions is important too, since each of them can contribute to issues at the front desk.

How to File Dental Insurance Claims

Now let’s get a bit more specific, with a quick overview of how to file dental insurance claims.

About two-thirds of patients have dental insurance, meaning that dental practices are generally having to handle a lot of claims at once. Here’s how it’s done.

Step 1: Collect insurance info from patient. It’s essential to keep this information on file, documenting anything an insurance provider may request (such as the patient’s policy number, birth date, and social security number).

Step 2: Submit claim and notify patient. A majority of dental claims are submitted electronically, though some insurance providers require paper claims. In either case, any relevant documents should be submitted along with the claim, and patients should be notified that their claim was sent.

Step 3: Refile claim, if necessary. In a perfect world, all claims would be addressed and paid right away. In the real world, practices often have to refile — and sometimes refile again — before payment comes in. Refiled claims are generally sent out every 30 days. Depending on the policy of the practice, bills may be passed onto patients if they’re not paid within a certain time frame.

Step 4: Get approved (or not). Insurance providers respond to claims by either approving the claim and sending payment or not approving the claim and denying payment. In the latter case, patients must take on responsibility for the bill.

As you can see, dental claim processing is a lot of work, especially for an already over-worked front desk staff. That’s why we started NMG Practice Solutions: to ease the burden and make it easier for practices to get paid. Check out our services to learn more about how we do it, or contact us for info on how we can help you.