Denied dental insurance claims are a major challenge for dental practices. A denied claim has pervasive effects on the entire dental office, affecting everything from administrative burdens to increased financial strain.

The modern-day dental office has faced a circulation of problems ranging from income decreases, inflation, and increased no-show rates, all of which affect the livelihood of a dental practice.

Insurance claims make up 50% of the revenue for in-network dental practices. That means half the revenue of a practice is at risk due to preventable claim denials. That is an unbelievable statistic and should have woken you up now to the situation and its root cause—missing information.

While claims can be denied for various reasons, missing information is the most common and preventable cause of claim denials. Even minor omissions can lead to rejected claims, requiring time-consuming corrections and resubmissions.

Missing information is a vast and vague reason why insurance claims are being denied and practices are put in financial jeopardy. Let’s review what missing information means before we can work to fix it.

Examples of Missing Information

Some of the most common missing information errors include:

• Incomplete Patient Information – Errors in patient names, birthdates, or insurance ID numbers. These minor issues can lead to denials, and even a small typo can result in processing delays.
• Incorrect or Missing CDT Codes – Dental procedures must be coded properly. Using outdated or incorrect codes can cause an immediate rejection.
• Lack of Required Documentation – Many procedures require supporting documents such as X-rays, periodontal charts, or narratives. Missing these attachments can prevent claims from being approved. 
• Missing Provider or Practice Details – If a claim lacks essential provider information, including tax ID numbers or NPI numbers, it may be automatically rejected by the insurer.

The Cost of Denied Claims

Denied claims are more than just an inconvenience; they are a revenue drain that can cost 5-10% of a practice’s annual revenue for a small to medium-sized clinic, which can be anywhere from $50,000 to $100,000. Bigger practices feel this cost on a much more drastic scale.

Delayed payments from claim denials further strain dental practices by burning up valuable correcting and resubmitting claims, placing these tedious tasks on administrative tasks. When claim denials are at an all-time high, staff can spend days to weeks correcting these issues.

Time is costly in the dental field, and small practices feel the pain of claim denials even more so. Denials have a significant financial impact, one that smaller clinics do not have the resources to roll with. It is crucial to prevent them before they occur.

How to Prevent Missing Information in Claims

Reducing claim denials due to missing information requires a proactive approach. Dental practices can improve their claim acceptance rates by following these key strategies:

• Verify Patient Information in Advance – Ensure all patient details, including insurance eligibility, are accurate before submitting claims. Regularly updating patient records can prevent unnecessary errors.
• Use Standardized Claims Checklist – Implement a checklist to confirm all required fields, CDT codes, and supporting documents are included before submission.
• Train Staff on Documentation Requirements – Insurance policies and coding guidelines change frequently. Ongoing staff training can help prevent avoidable mistakes.
• Leverage Technology for Claims Processing – Technological billing solutions, such as AI-powered ones, can automatically detect missing information before claims are submitted, reducing errors and improving efficiency.

Final Takeaway

While claim denials can be frustrating, they are often preventable. Missing information remains the top reason claims are rejected, but with the right processes in place, dental practices can reduce denials, accelerate reimbursements, and improve overall financial health.

By implementing verification protocols, using checklists, training staff, and potentially integrating smart billing solutions, practices can ensure claims are submitted accurately the first time – minimizing delays and maximizing revenue.