Resources for dental offices
Dental claims can be tricky, but they don’t have to slow down your office. Whether you're handling insurance submissions for routine cleanings or more complex procedures, following a clear process can save your team time and reduce costly errors. In this guide, we’ll walk you through practical steps to streamline dental claims processing, from verifying patient insurance and using the correct CDT codes to tracking submissions and managing denied claims.
May 1, 2025
1. Verify Patient Insurance Information Thoroughly
Insurance verification is a safeguard for your revenue cycle and your patient experience. The most reliable approach is to verify insurance at three points:
At the time of scheduling
48–72 hours before the appointment
During check-in
This triple-check system catches last-minute policy changes, job transitions, and expired coverage that could otherwise lead to claim denials or unexpected balances.
Use the right tools for the job:
Insurance portals offer direct access to eligibility, but can be time-consuming if your team is juggling multiple carriers.
Clearinghouses provide centralized access across insurers, saving time in busy practices.
AI-powered tools like Weave or mConsent integrate with your practice management system, reducing verification time to under a minute per patient.
Phone verification remains useful in complex cases, particularly when digital records are incomplete or benefits are difficult to interpret.
Take time to review the plan’s financial structure and limitations, including annual and lifetime maximums, any remaining deductibles, coverage percentages for planned procedures, waiting periods and frequency limitations, and plan exclusions that might impact treatment.
Missing one of these details can result in denied claims, patient frustration, and added collection efforts for your team.
Verification should be part of the patient conversation. A quick question like “Has your insurance changed since your last visit?” often surfaces important updates and reinforces your commitment to transparency and care.
2. Document Services in Detail
Complete clinical documentation drives claim approvals in dental claims processing. Every service you document should include comprehensive patient information, relevant histories, detailed clinical findings, specific diagnoses, and clear dental treatment plans.
Use thorough documentation methods, such as SOAP notes, to capture all necessary information.
It’s also worth noting that claims with proper diagnostic materials see higher approval rates than those without. Your required attachments include:
Pre-operative radiographs showing why the procedure was necessary.
Intra-operative images documenting procedure stages.
Post-operative radiographs confirming completion.
Clinical photographs showing what radiographs might miss.
Periodontal charts documenting disease progression.
Narrative reports shine for procedures coded as "by report" under CDT. Skip vague statements like "patient needed crown" and get specific: "Patient presented with fractured tooth #30 with pulpal involvement requiring endodontic therapy and full coverage restoration due to extensive loss of tooth structure."
3. Utilize Correct Coding Practices
CDT codes are the universal language between your practice and insurance companies during dental claims processing. These standardized codes, updated annually by the American Dental Association, precisely describe what services you performed.
Getting coding right directly impacts your bottom line. Under-coding (using codes that downplay service complexity) bleeds revenue, while over-coding (exaggerating what you did) can trigger fraud investigations.
A solid understanding of terms and codes, facilitated by a dental terminology guide, is necessary. Watch out for these common pitfalls:
Using outdated codes
Missing specifics like tooth surfaces or quadrants
Incorrect code sequencing for multiple procedures
Documentation that doesn't support your chosen codes
Mishandling different insurance plans with varying requirements
4. Submit Clean Claims Promptly
A "clean claim" has all required information formatted exactly as the payer wants it. This means accurate procedure dates, tooth numbers, quadrant details, and complete subscriber information.
What makes claims "unclean"?
Missing or incorrect provider NPI numbers
Invalid subscriber identification numbers
Improperly documented place of service
Missing referral or pre-authorization numbers
Incomplete procedure details
Remember that insurance companies enforce strict submission deadlines, typically 90–180 days from the service date. File too late and you'll face automatic denial, no matter how valid your claim. Electronic submission gives you a significant advantage, as many insurers process electronic claims in 7–14 days versus 30+ days for paper submissions.
Create standardized claim preparation protocols and quality checks to catch errors before they reach insurers. Many practices find that daily claim batching works better than weekly, and you'll see steadier cash flow and spot systemic issues faster.
5. Monitor Claim Status Regularly
Without systematic tracking, claims can slip through cracks and exceed filing deadlines. You can use these tracking approaches:
Practice management software reports that flag unpaid and aging claims.
Clearinghouse dashboards track claims across multiple payers.
Direct insurer portal monitoring for your highest-volume carriers.
Aged claims reports highlighting stalled reimbursements.
Tracking dental KPIs such as denial trends, aging claims, and carrier-specific processing times can pay off. Set up weekly audits for pending claims and daily reviews for claims approaching filing deadlines. Watch for these red flags:
Claims pending beyond typical processing windows
Multiple pending claims with the same insurer
Unusual patterns in specific procedure code denials
Delays involving high-value treatments
Consider creating a dedicated role or specific time blocks for claims monitoring. Many successful practices hold "claims huddles" where team members tackle aging claims together, sharing insights and solutions.
6. Address Denied Claims
Even meticulously prepared claims sometimes get rejected. Understanding why helps you develop targeted solutions. Top rejection reasons include:
Incorrect or incomplete patient information.
Inaccurate procedure codes.
Missing pre-authorization.
Insufficient clinical documentation.
Coordination of benefits issues.
Non-covered services.
Timely filing violations.
When denials occur, analyze the explanation of benefits (EOB) and the insurer's reason codes to pinpoint what went wrong.
Improving patient communication and case presentation can also help improve dental case acceptance, which in turn supports smoother claims processing. Successful appeals require strategy:
Review the denial reason in detail
Gather additional supporting documentation
Prepare a concise appeal letter citing specific policy provisions
Submit within the appeal timeframe (typically 30–180 days)
Follow up if you hear nothing within 30 days
Track denial patterns to find and fix systemic issues. If you're seeing multiple "lack of medical necessity" denials, you should beef up your clinical documentation standards.
7. Maintain Compliance with Regulations in Dental Claims Processing
Regulatory compliance directly affects claim approvals and protects you from financial penalties. Primary compliance areas include:
HIPAA regulations on patient information privacy and security.
Insurance fraud regulations prohibiting service misrepresentation.
Documentation requirements for record content and retention.
Electronic transaction standards for claim format and transmission.
Your documentation must:
Be maintained for at least seven years (longer in some states).
Include proper patient signatures for treatments and information release.
Follow specific electronic documentation standards.
Have audit trails for all record modifications.
Prepare for potential audits with quarterly self-assessments of documentation completeness, code accuracy, and payer policy adherence. Think of each patient record as a legal document that may be scrutinized by regulators or insurance auditors.
8. Consider Outsourcing Billing Services
For many practices, outsourcing billing provides specialized expertise without expanding staff. Outside billing services focus exclusively on dental claims processing, often delivering better results due to their specialized knowledge.
The benefits include:
Access to billing specialists who know multiple insurance plans inside and out
Reduced administrative workload for your in-house team
Better accuracy in catching expired or invalid insurance policies
Consistent claim submission regardless of staff absences or turnover
Cost structures typically follow either a percentage of collections (ranging from 4–9%) or flat monthly fees based on practice size. When calculating ROI, consider not just direct costs but also the impact on collection rates and staff time. Research shows that practices that outsource billing typically see up to a 10% increase in collected revenue within the first year.
When selecting a billing service, evaluate:
Dental-specific experience (medical billing services often lack dental expertise)
Technology platforms compatible with your practice management software
Reporting capabilities that show claim status clearly
Communication protocols for handling patient billing questions
Plan the transition carefully to maintain revenue continuity. Most practices use a phased approach, starting with new claims while gradually transitioning outstanding balances.
9. Invest in Staff Training
Staff education directly impacts your claim acceptance rates. Your team needs thorough training in insurance verification, CDT coding, documentation standards, and technology use.
Investing in staff training not only improves claim acceptance but also helps maximize dental practice profits. Effective training approaches include:
Formal education programs from professional associations
Certification courses with recognized credentials
On-the-job training with experienced team members
Team workshops addressing specific claim challenges
Valuable credentials include the AAOMS Coding Certificate Program and coding certifications from organizations like the AAPC. Additional helpful resources include the ADA's CDT coding manuals, online courses, and specialized coding training.
Invest in regular coding and billing training, and you will most likely see improvements in claim acceptance rates. Also, cross-training helps clinical staff understand how their documentation affects coding while administrative staff grasp the clinical rationale behind procedures.
Set aside time for weekly team huddles to review recent denials and share successful strategies. This approach turns individual learning into practice-wide knowledge that benefits everyone.
10. Leverage Technology Solutions
Modern technology, including advancements in AI in dental practice management, simplifies dental claims processing while improving accuracy. Strategic tech investments deliver measurable improvements in reimbursement speed and success rates.
Practice Management Software forms the foundation of successful claims processing. Systems like Adit DPMS, Dentrix, and CareStack automate billing workflows, flag potential errors before submission, and track claims throughout the revenue cycle.
Dental clearinghouses validate claims before submission, catching potential issues before they reach insurers. Solutions like DentalXChange offer pre-validation services that significantly reduce rejection rates.
Revenue Cycle Management tools provide analytics that identify reimbursement patterns across procedures, carriers, and providers. These insights help you make smart decisions about insurance plan participation and fee schedule negotiations.
Integrated claims management centralizes the entire process, from eligibility verification through payment posting. This eliminates information silos that often cause errors and delays.
Leveraging technology to automate administrative tasks can reduce manual errors.
Make Dental Claims Easier for Your Team
Processing dental claims doesn’t have to be a hassle. When your team follows the right steps, like double-checking insurance, using the correct codes, and keeping track of claims, you’ll see fewer delays and get paid faster. It also helps your office run more smoothly and keeps patients happy by avoiding billing surprises.
But even the best systems can fall apart if you’re short on staff; that’s where Teero comes in. Teero makes it easy for dental offices to find qualified hygienists fast, whether you need someone for the day or you're looking for longer-term help. Your team can stay focused, your schedule stays full, and your claims keep moving. Check out Teero to find trusted dental hygienists whenever and wherever you need them.