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Responding to Claim Rejections

clipchart with checklist stamped rejected

Making sense of claim rejections from third-party payers can be a little frustrating at times. With the onslaught of patients using new consumer-directed employee benefit plans, knowing how to correctly code procedures and responding to claim rejections has become even more important.

Navigate the sometimes complicated world of claim rejections with this special guide: Responding to Claim Rejections. Below is a sneak peek at what’s contained within the guide, which you can download for your own use at any time by clicking on the “Supporting Materials” link.

A. Common Claim Denials

1. D4341 Periodontal Scaling and Root Planing
2. D4910 Periodontal Maintenance
3. D2950 Core Buildup, Including any Pins

B. Preventing and Resolving Errors

1. Using the Correct Codes
2. Avoiding Procedure Code Errors
3. Coding and Reimbursement
4. Determining the Date of Service

C. Cost Containment Features

1. Bundling
2. Downcoding
3. Least Expensive Alternative Treatment (LEAT)
4. Pre-existing Conditions
5. Exclusions
6. Plan Frequency Limitations
7. Not Dentally Necessary

D. Coordination of Benefits (COB)

1. ADA Guidelines on Coordination of Benefits for Group Dental Plans

E. Provider Contract Issues

1. All Affiliated Carriers Clauses
2. National Processing Policies
3. Billing for Component and Denied Procedures
4. Specific Provider Relations Representative Contacts
5. Removal from Network Lists

F. Explanation of Benefits (EOB) Language

G. Electronic Claim Submissions

H. How to Receive Assistance

1. Claims Appeals
2. State Insurance Commissioner’s Office
3. Department of Labor
4. Patient’s Employer’s Human Resources Department
5. The American Dental Association
6. ADA Contract Analysis Service

I. ADA Resources

Supporting Materials

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