Where Do I Even Begin?! – Tricks & Tips Lowering Outstanding Claims
Do you find yourself with an Insurance Claim Report that is 5, 10, or even 40 pages long? Have you recently joined a practice with unpaid claims reaching back four years?!
Where do you start?
There are many ways to tackle this large yet significant challenge. You can print the reports directly from your practice management software and go line by line. If you have third-party software, you can pull a live report and work from the top by date of service, insurance carrier, etc.
I joined a practice a few years ago with $400,000 of outstanding insurance claims. Within a month, I had collected almost 100% of that.
How did I do it?
Let’s dive in!
Aging Report
I ran an Insurance Aging Report from our PMS, Dentrix. I then exported that report to Excel and cleaned up the following columns:
- Date of Service
- Patient Name
- ID#
- Birthday
- Insurance Carrier
I used Excel to filter my results by service date and first tackled the claims with the oldest date. You can also filter by the claim amount, allowing you to tackle the largest dollar amount first.
Insurance Portal Access
I began by looking up the claim I am working on in the Insurance Carrier’s portal. Insurance portal access is critical in a dental practice’s workflow because we don’t have 631 hours to sit on hold to ask a representative to answer our questions.
Verify Accuracy
If the claim does not appear in your portal, do not just resubmit it! Verify the patient’s name is spelled correctly, and their birthdate is correct.
TIP: Sometimes insurance has the wrong birthday! At that point, you’ll need to get the patient involved to correct it.
Confirm the patient was active with that insurance on that date of service using your portal. Check that your payor ID is correct for your clearinghouse.
Resubmit
If all of these things are confirmed and corrected, resend your claim.
TIP: If your insurance portal allows you to submit claims online, this is a perfect opportunity to do so directly!
Does the claim appear in your portal? What does the EOB say? Was it denied; send an appeal. Is insurance requesting additional information?
I have learned [the hard way] that, more often than not, if you resubmit your claim trying to send in further information, it will be automatically denied. To ensure your claim will be received as a resubmission, you can call, fax, email, or snail-mail the carrier with a new NEA attachment #, a copy of the claim with the claim # in the remarks section, AND a copy of the EOB.
This will help their processing teams realize they need to reprocess and not just decline. Once you have sent one of these methods, THEN resend it electronically.
Track Your Process
In your Excel sheet, create a comment column. Within there, you can add your notes on what was wrong with the claim and what action(s) you took to have it reprocessed. These notes can then be copied and pasted into your PMS software.
Continue to your next claim. Set aside half a day per week to focus on your outstanding claims uninterrupted (if possible). Sometimes, you will have to call an insurance company to determine the status, and that is okay.
Sharing this information with you is to provide common reasons for outstanding claims. Remember to verify that the information in your software is correct and that the patient is active. More importantly, only resend a claim after checking all the reasons it could be denied first.
Wishing you happy collections and a one-page outstanding insurance claim report!
About the Author
Tiffany Yeckel, MAADOM
Tiffany Yeckel, a Virginia native, started in dental over 11 years ago. She was inspired to work in dentistry because of her experiences as a patient with the dentist, and she now manages the practice!
She enjoys being able to connect with patients who are undergoing procedures that she has experienced first-hand.
Tiffany has been a member of AADOM since 2019, received her Fellowship (FAADOM) in 2022 and Mastership (MAADOM) in 2024.
