Due to stringent filing requirements imposed by carriers, claims are often denied because of simple errors. Some of the most common simple errors are:
1) Incorrect patient identification code. A Required field. Plans only pay benefits for a valid ID number.
2) Incomplete or incorrect dates of service. A Required field. Month, date and year are required.
3) Incorrect or missing place of service. A Required field. Plans accept two digits or two letters; each plan has different preferences.
4) Incomplete or unrecognizable code numbers. A Required field. Plans add and delete codes at their own pace; the Dental Office must be aware of the codes the plan accepts, as well as the modifiers, if any, it uses.
5) Incorrect provider number. A Required field. Each provider must have a unique provider number.
6) Missing name and address of facility where services where rendered. A Required field. This is especially important when services are provided at multiple offices by the same provider.
7) Missing plan code or group number. A Required field. Plans require a plan code or group number.
8) Wrong or missing revenue code. A Required field. Plans require correct revenue codes.
9) Failure to list initial placement for services with limitations (such as crowns once in five years, dentures, etc. A Required field. Failure to list usually results in delay in payment until information is obtained.
10) Failure to list tooth numbers. A Required field. Payment will be delayed or denied unless this information is provided.
11) Failure to send x-rays. Required for certain procedures or dollar amounts. Many plans will reject claim outright if x-rays are not received.
12) Failing to provide a narrative for "999" codes. Required. Services reported under 999 codes (by report procedures and miscodes) require a report by the provider to explain exactly what is being done and provide any documentation to support why the services is of an unusual nature and is to be priced at a higher level than other services. If this documentation is not provided the claim will be rejected.
13) Failure to indicate the Dental Office has assignment of benefits. Recommended field. Although not required, failure to list this item can result in payment being sent to the patient instead of the Dental Office.