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Claims that are not covered by your Dental Plans may be covered by the Medical Plan

At this time there are numbers that have been published on the loss of income when receiving denials and are asking for more information due to the lack of information.

Potential Financial Impact of Denials

Denied claims per month – 99

Rework cost per claim – $25

Rework cost per month – $2,475

Annual rework cost – $29,700

*Example assumes 370 visits per month, one claim line per claim, and a denial rate of 27%.

I have a clue you are not looking at these numbers and understanding how much loss between accepting lower fees and claims unpaid how will you be able to stay in a healthy margin of cash flow?

I have a few tips:

  1. Missing information- examples include even one field left blank, missing modifiers, wrong plan codes, incorrect or missing social security number
  2. Duplicate claim for service- when claims are submitted more than once for the same service provided, same beneficiary, same date, same provider, and single encounter
  3. Service is already adjudicated- (unbundling) services.  Benefits for a service are included within another service or procedure
  4. Services not covered by payer- before providing services, check details of eligibility or call the payer to determine coverage requirements
  5. The limit for filing has expired- there is a set number of days following service for a claim to be reported to the payer.  If outside of that time, the claim will be denied.  Included in this period is time to rework rejections

We will be announcing a web program to learn all the ins and outs.

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