Dental billing, worked to dental rules
Dental code sets, attachments and narratives, and a payer landscape that works nothing like medical.
What makes Dental billing hard
The issues we watch on this specialty
- Benefits that run out mid-planAnnual maximums and frequency limits mean a covered procedure can still be unpaid.
- Attachments decide the claimRadiographs, charting and narratives are often what a payer bases its decision on.
- Alternate benefitsPlans may pay for a less costly alternative, leaving a balance the patient should be told about in advance.
Overview
How Dental billing works with us.
Dental billing has its own claim form, its own code set and its own benefit design. Annual maximums, frequency limits, waiting periods and alternate-benefit clauses decide what a plan pays, and each one can be checked before treatment rather than discovered afterwards.
Kitronixe works dental claims for general and specialty practices, including where treatment crosses into medical coverage.
The problem
Where Dental revenue leaks.
Benefits that run out mid-plan
Annual maximums and frequency limits mean a covered procedure can still be unpaid.
Attachments decide the claim
Radiographs, charting and narratives are often what a payer bases its decision on.
Alternate benefits
Plans may pay for a less costly alternative, leaving a balance the patient should be told about in advance.
Coding
What the coding actually involves.
Dental procedures are reported with a separate code set from medical procedures, and some treatment is billed to a medical plan instead. Code selection should be checked against the clinical notes and the current edition of the code set; any policy-specific statement added here needs a source and effective date in the Governance tab.
Denial prevention
Known risks, and what we do about them.
Denial risk
Frequency limitations
How we respond
Treatment history checked against the plan before scheduling.
Denial risk
Missing documentation
How we respond
Attachments assembled before the claim is sent.
Denial risk
Waiting periods
How we respond
Plan effective dates confirmed at verification.
Payers
How payers treat Dental.
Pre-treatment estimates
Many plans offer predeterminations for larger treatment plans; they set expectations but are not a guarantee of payment.
Related
What we would run for you.
Service
Dental Billing
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Payment Posting
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Credentialing
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Eligibility Verification
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A/R Recovery
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Denial Management
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Practice settings that bill Dental
See what your dental revenue cycle is losing.
An assessment reviews your denial rate, clean claim rate, A/R ageing and charge lag, and reports what it finds - whether or not you work with us.