Denials and delays in processing claims are not intentional and not used to accrue interest from amounts owed. Rest assured that in accordance with Guardian policy guidelines, a dentist licensed in the United States is reviewing and processing claims and making any denial decisions. To avoid delays in processing, it is best to submit all supporting documentation related to the claim as soon as reasonably possible. Submissions must include current diagnostic pre-operative periapical or bitewing x-rays, patient chart notes and any relevant intraoral photographs. Pre-treatment estimate is strongly recommended.
Clear communication and understanding are essential to the success of any relationship. In an insurance context, understanding the meaning of key terms can help avoid errors with bills and claims. For example, let’s take the difference between disallowed and denied: disallowed means the fee you charge is not payable by the insurer and cannot be charged to the patient. While denied means the fee you charge is not payable by the insurer but can be charged to the patient.
Diagnostic radiographs are not only important when assessing a patient’s health, but their quality may impact claim processing times and the rate of prompt payment—best to submit exactly what’s needed the first time. Each tooth being evaluated should be shown clearly on the x-rays—they should not be too dark, too light, and/or blurry. For extractions, the extraction site without the tooth cannot be used to decide a claim. The tooth to be extracted needs to be shown. When it comes to scaling and root planing, the teeth and bone levels should be seen on the radiographs. Finally, it may be best to submit bitewings and/or periapicals, as often panoramic x-rays do not provide diagnostic data.
Knowledge is power. And having a digital space, where patients can go anytime, from anywhere to access information on benefits and coverage also affords valuable flexibility. Portals like Guardian Anytime make it possible for you and your patients to verify insurance benefits, while also helping to reduce customer service call volume for the insurer.
Some plans may have a missing tooth policy that states that any tooth lost before the insurance coverage start date will not be covered for replacement. Before replacing a tooth for a patient, it’s advisable to get pre-authorization. This will help save the patient from receiving an unexpected bill and saves you and the insurer from handling appeals. This will also help you know the exact amount to collect from the patient and expect from the insurer for any services you do provide.
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