Collect Complete Demographics: Stop Rejections Before They Start

The ADA's standardized claim form for insurance billing requires 25 specific data points. Federal regulations set additional requirements. Capturing these fields correctly the first time prevents downstream rework and protects your revenue cycle.

Your registration form needs these critical demographic fields:

• Full legal name exactly as it appears on the insurance card to match carrier records

• Date of birth with correct formatting for age-based eligibility validation

• Patient relationship to subscriber (Self, Spouse, Dependent Child, Other) for coverage validation

• Complete mailing address including street, city, state and ZIP code

• Contact phone numbers for claim follow-up and coordination of benefits

• Student status for dependent eligibility extensions

Missing any of these fields triggers automatic claim rejections before your submission even reaches the insurance company. Formatting errors get rejected at the clearinghouse level. Train your front desk to verify each field before the patient leaves the registration desk.

Verify Insurance Details: Get Paid Faster

Your registration form collects demographic information, but insurance verification requires going deeper. Dental plans can reflect eligibility changes retroactively and recoup funds when treating patients who have lost coverage. Confirming coverage details before treatment protects both your practice and your patients from surprise bills.

Verification means confirming these essential elements:

• Active coverage status and effective dates to confirm current insurance on date of service

• Annual plan limits before providing services

• Benefit coverage percentages by category: Most plans follow the 100-80-50 coinsurance model, covering preventive care at 100%, basic procedures at 80% and major procedures at 50%

• Deductible information: annual amounts and remaining patient responsibility

• Coverage limitations: frequency restrictions, waiting periods and plan exclusions

• Policy and group numbers matching the insurance card exactly

Each piece prevents a specific denial type. Industry benchmarks set the clean claim rate standard at 95%. Practices below this threshold have quantifiable gaps in their verification process that contribute to denials.

Subscriber Information for Dependent Coverage

When your patient isn't the policyholder, the claim needs the primary policyholder's complete details. Collect the subscriber's full name in Last, First, Middle Initial, Suffix format along with their date of birth and relationship to the patient.

The birthday rule helps determine primary insurance coverage for dependent children when both parents have insurance and there is no court order or legal custody agreement specifying otherwise. In such cases, the parent whose birthday occurs first in the calendar year (based on month and day) typically holds primary insurance. However, legal agreements or custody arrangements can override the birthday rule.

Secondary insurance represents a critical coordination of benefits element that, when missing, contributes directly to denials attributed to registration and eligibility verification failures.