Filing Medical Insurance in a Dental Office

Written by Heather Siler

Has your dental practice ever filed a medical claim? While not a common occurrence in dentistry, there are instances where filing a dental claim on a patient's medical insurance is permissible. Furthermore, filing medical insurance can be very helpful to the patient and profitable for your office.

Procedures that may be covered include:

  • exams/consultations
  • Sleep Apnea appliances
  • TMD devices
  • Appliances used in breaking habits- e., thumb sucking
  • Orthodontic appliances
  • Some surgical procedures
  • Periodontal surgery
  • Bone and tissue grafts
  • Some implant surgeries
  • Traumatic injury cases
  • Biopsies
  • Interim prosthesis during trauma cases or after radiation or chemotherapy
  • Final prosthesis after trauma
  • Crowns, bridges, and other removable and fixed prosthesis following cancer treatment

Filing a medical claim is nothing like filing a dental claim, and even the most skilled insurance coordinator will have much to learn. There are many seminars on processing medical claims live and online. Your dental rep should be able to locate these resources for you. Basically, four steps are crucial to getting the claim paid quickly.

Step one is ensuring that the dentist is properly credentialed. This credential is granted through the Council for Affordable Quality Healthcare (CAQH) and isn’t the same as being a participating provider in a medical insurance company’s network.

Step two is filing the claims electronically. Paper claims aren’t permitted which usually isn’t a problem since most offices file electronically anyway.

Step three is obtaining preauthorization before proceeding with treatment. In dentistry, preauthorizations can be time-consuming and inaccurate. However, with medical insurance, preauthorizations are often required. There are clearinghouses portals online that make preauthorizations quicker and less of a headache.

Step four is using the proper format. Delivery of treatment won’t change, but chart notes and reporting information in the patient’s electronic records will have to be in the correct format. In addition, clinical notes are legal documents and must be written by the doctor and no other team members.

The entire dental team should be on board with this process. Although it will be a bit of a learning curve, mastering the art of filing medical claims successfully in the dental office will be beneficial to your patients and your practice.