Resources for dental offices
Denied dental claims drain your practice's cash flow and pile stress on your team. Each rejected claim delays payment and costs you real revenue that could fund payroll, new equipment, or that operatory expansion you've been planning. Most denials trace back to preventable mistakes: missing data, late filings, and unclear documentation. You can fix these patterns with a systematic follow-up approach that closes gaps, reduces denials, and speeds up payments. The four-step framework below will help you build that system and see measurable improvements in your acceptance rates and revenue flow.
Sep 30, 2025
Step 1 – Information Preparation and Documentation Management
Complete preparation and systematic documentation transform follow-up calls from detective work into focused status checks. Incorrect or missing information remains one of the main reasons claims get rejected, so gathering everything upfront protects revenue and saves time. When you organize files systematically, each follow-up conversation becomes productive rather than frustrating. Your preparation directly determines whether payer representatives can resolve issues immediately or need to schedule callbacks for missing information.
Essential Information Categories
Organizing claim information into clear categories helps you locate details quickly during phone calls and prevents important elements from being overlooked. Each category serves a specific purpose in the follow-up process, and missing elements from any category can delay resolution. Think of this organization as building a complete case file that tells the story of each patient encounter.
Patient Policy Information:
Patient ID
Demographics
Policy number
Group number
Last verification date
Breaking down service information into discrete elements helps you communicate precisely with payer representatives about what was done and when. Clear service details prevent confusion about procedures, timing, and authorization requirements that often lead to unnecessary claim delays. This category forms the foundation for all follow-up conversations.
Service Details:
Date of service with matching CDT codes
Original submission date and method (electronic or mail)
Pre-authorization reference numbers
Supporting documentation provides the clinical justification that payers need to approve claims, especially for complex procedures or higher-value treatments. Having these materials organized and easily accessible means you can respond immediately to documentation requests rather than scrambling to locate records. Complete documentation often means the difference between quick approval and lengthy appeals.
Supporting Documentation:
Chart notes, X-rays, photos, narratives
Pre-treatment authorizations
Previous payer correspondence
Contact Documentation Requirements
Thorough documentation serves multiple purposes beyond just keeping records—it demonstrates your professionalism to payers, provides legal protection for your practice, and creates accountability for payer representatives. The quality and completeness of your documentation often determines whether disputed claims get resolved in your favor. When payers see detailed, professional records, they understand that your practice operates systematically and takes compliance seriously.
Required Contact Documentation:
Date, time, representative name, reference number
Current status and issues identified
Promised actions with timeframes
Next follow-up date
Storage and Organization Systems
Where and how you store your documentation determines whether your team can access critical information when it's needed most. A centralized system prevents information from getting lost when team members are absent or when claims require immediate attention. Your storage system should make it easy for any team member to understand the complete history of a claim and know exactly what needs to happen next.
Use your practice management system for central access. Color-code by status: green (processing), yellow (pending documentation), red (appeals needed). Record conversations immediately while details remain fresh and accurate, as memory fades quickly and important details can be lost or confused. Include exact quotes about requirements or timelines to prevent misunderstandings later and to hold payers accountable for their commitments. Tag approaching deadlines for priority follow-up to ensure no claim falls through the cracks due to timing issues.
Most carriers impose filing deadlines that vary by contract and procedure type. Complete preparation and systematic documentation keep you ahead of these deadlines and speed resolution by eliminating back-and-forth requests for additional information.
Step 2 – Strategic Payer Communication
Your communication strategy should progress systematically from initial inquiry to decisive escalation while building professional relationships that expedite problem resolution. This prevents claims from stalling while maintaining cooperative payer relationships. The timing and tone of your contacts directly influence how quickly payers respond and how seriously they treat your requests. A structured approach ensures you apply appropriate pressure at each stage without burning bridges or wasting time on ineffective tactics.
Contact Timeline Management
Your first contact sets the tone for the entire follow-up process and often determines whether a claim moves forward smoothly or requires multiple touchpoints. The timing of this initial contact matters because calling too early means the claim may not be in the system yet, while calling too late risks missing important deadlines. Your approach during this first conversation establishes your credibility with the payer representative and demonstrates your practice's professionalism.
Strategic Contact Timeline:
Electronic submissions: Initial contact at 14 days
Mailed claims: Initial contact at 21 days
Escalation trigger: 10 business days without resolution
Approaching filing deadline: Immediate escalation required
Communication Scripts and Escalation
Professional communication starts with a clear, respectful script that gets straight to the point while providing all necessary information. This approach respects the representative's time while ensuring you get the information you need to move forward. Your tone should be businesslike but friendly, treating the representative as a partner in resolving the claim rather than an adversary.
Initial Contact Script: "Good morning, this is [Name] with [Practice]. I'm calling about claim #[Number] for patient [Patient], submitted [Date] for [Procedure]. Could you confirm its current processing status?"
If pending: "Is any additional documentation needed to finalize this claim today?"
When initial contacts don't resolve claims, escalation becomes necessary to protect your practice's revenue and maintain cash flow. The key to successful escalation is timing it appropriately and maintaining professionalism while increasing urgency. Escalation works best when you can demonstrate that you've followed proper procedures and that the delay is impacting your ability to provide patient care.
Escalation Script: "I've been following up on claim #[Number] for [Patient] since [Date]. Your policy indicates [X] days turnaround; today is day [Y]. Could you start a supervisor review?"
Written Communication and Appeals
Written appeals provide a permanent record of your requests and often receive more serious attention than phone calls alone. Switching to written communication also protects you legally and creates documentation that can be valuable if the claim requires external review or legal action. The quality of your written appeals often determines whether claims get approved on first review or require multiple rounds of back-and-forth correspondence.
Use payer portals for written appeals when possible, as these create permanent records and demonstrate your professionalism. Attach pre-treatment authorizations to strengthen medical necessity arguments and provide clinical justification. Keep standard follow-up scripts handy but personalize them for each payer relationship based on what you know works best with their representatives. Note which representatives are most helpful and request them by name when possible, as this personal connection can speed resolution of complex issues.
Effective payer communication goes beyond just asking about claim status—it involves building professional relationships that can help expedite problem resolution. Your communication style and approach with payer representatives often determines how much cooperation you receive and how quickly issues get resolved. Consistency in your communication approach helps build recognition and credibility with payer representatives over time. Industry research shows practices lose significant potential revenue to unresolved denials in accounts receivable.
Step 3 – Pattern Analysis and Systematic Improvement
Monthly analysis transforms reactive follow-up into proactive revenue protection while implementing systematic corrections that prevent future denials. Your documentation reveals exactly where denials originate and how to stop them. Pattern analysis is where individual claim work becomes systematic practice improvement, turning your follow-up efforts into a strategic advantage. When you understand why claims get denied, you can fix the root causes rather than just treating symptoms.
Monthly Review Process
Regular analysis of your denial patterns provides insights that individual claim reviews simply cannot deliver. The monthly review cycle gives you enough data to spot meaningful trends while keeping the timeframe short enough to implement timely corrections. Your monthly reviews should focus on actionable insights rather than just generating reports, turning data into concrete steps that improve your revenue cycle.
Run denial reports by payer, procedure, denial reason, and provider to create a comprehensive view of your claim performance. Calculate denial rate using the formula: denied claims divided by total submitted, multiplied by one hundred. Track monthly trends to identify whether your improvements are working and where new problems might be emerging.
Pattern Recognition Strategies
Effective pattern recognition goes beyond just looking at numbers—it requires understanding the relationships between different variables and identifying the underlying causes of denials. Look for connections between specific providers, procedures, payers, and denial reasons to understand why problems occur. Your goal is to identify patterns that suggest specific solutions rather than general problems that are difficult to address.
Consider whether certain payers consistently challenge specific procedures, whether particular providers generate more denials than others, and whether coding errors concentrate in particular service areas. Each pattern you identify should point toward a specific action you can take to prevent future denials.
Systematic Correction Implementation
Once you identify patterns, implementing systematic corrections requires coordination between your administrative and clinical teams. The most effective corrections address root causes rather than surface symptoms, creating lasting improvements that prevent similar denials in the future. Your correction strategy should prioritize the changes that will have the biggest impact on your revenue and the simplest implementation for your team.
Systematic Corrections:
Update documentation templates for challenged procedures
Refresh CDT coding for commonly denied services
Add pre-authorization requirements for high-risk claims
Target provider education on specific payer requirements
Schedule quarterly reviews to assess progress and identify new improvement opportunities, ensuring your denial prevention efforts continue to evolve and improve.
Step 4 – Team Implementation and Workflow Management
Maximize your follow-up results with focused team coordination and workflow practices that keep claims moving and revenue flowing consistently. Consistent execution often matters more than perfect technique, as regular follow-up habits prevent small issues from becoming major revenue problems. The practices outlined below help you maintain momentum and ensure that your follow-up system works reliably even when your practice gets busy.
Follow-Up Scheduling and Time Management
Dedicated time blocks for claim follow-up work prevent this critical revenue function from getting pushed aside by daily patient care demands. When you schedule specific times for follow-up work, you create accountability and ensure that claims receive consistent attention regardless of how busy your practice gets. The timing and duration of these blocks directly impacts how effectively you can work through your aging claims and maintain cash flow.
Set specific days for claim follow-up work, with Monday mornings working well for most practices because you can start the week by clearing claim backlogs before patient care begins. Block uninterrupted time periods so you can work through your aging report systematically without constant interruptions from other practice activities. Consider the natural rhythm of your practice when scheduling these blocks, avoiding times when you're typically dealing with patient emergencies or high-volume appointment scheduling.
Team Coordination and Accountability
Clear team roles and cross-training ensure that claim follow-up continues smoothly even when key team members are absent or when practice volumes fluctuate. Your team coordination strategy should balance specialization with flexibility, allowing team members to develop expertise while maintaining coverage for critical functions. The way you organize team responsibilities for claim follow-up directly impacts both the quality of your results and your team's ability to handle the workload consistently.
Assign claim follow-up to specific team members so accountability stays clear and no claims fall through the cracks when responsibilities are unclear. Cross-train at least two people on your follow-up process so vacation coverage doesn't create claim backlogs that impact cash flow. Brief the clinical team on common denial reasons so they can adjust documentation practices and prevent future problems at the source.
Progress Tracking and Performance Monitoring
Visual progress tracking helps maintain momentum and allows you to spot problems before they become major revenue issues. Your tracking system should be simple enough that team members use it consistently while providing enough detail to guide decision-making and improvements. The tools you choose for tracking progress should integrate naturally into your existing workflows rather than creating additional administrative burden.
Use simple tools like color-coded spreadsheets or practice management flags to track claim status at a glance, making it easy to prioritize work and identify urgent issues. Set automatic reminders for follow-up dates so no claim slips through the cracks due to timing oversights or busy schedules. Celebrate monthly improvements in denial rates to keep momentum strong and recognize team members who contribute to better results.
Keep Claims Moving; Partner With Teero
Apply the four-step follow-up plan and you cut denials, shorten payment cycles, and win back hours for patient care. Yet the plan works only when your team has space to work the phones, log every touchpoint, and spot patterns in denial reports. When the front desk is juggling late arrivals and ringing phones, claims drift past filing windows and revenue stalls.
Teero's on-demand hygienists fill chairs so your administrative staff can focus on the revenue work—calling payers, uploading x-rays, and resubmitting appeals before deadlines hit. You choose the coverage you need, whether it's a single afternoon or a month-long backlog push, and vetted professionals arrive ready to help. The result: steady cash flow, calmer teams, happier patients.
Sign up for Teero to experience how flexible staffing frees your front office to master claim follow-up.