Always appeal denied claims, unless it is due to waiting period, maximum, frequency or things that cannot be overturned.
Ask for or locate the correct appeal’s address and who to make it attention to. This is not always their regular mailing address.
Give them more information than they could ever want. (i.e. pre and post x-rays, clinical notes, detailed written narrative from the doctor with add. information, IO photos, perio chart if needed, use the CDT book guidelines for the code guidelines)
Circle/highlight and point out the evidence you have. i.e. fractures in the teeth, decay on your IO photos and x-rays. Make it obvious to the consultant!
Don’t stop after one appeal. Ask for a peer-to-peer review! Appeal up to four times. Each time a new consultant reviews the claim. Get your insurance commissioner involved, if need be.
The squeaky wheel gets the grease! Insurance companies are counting on you NOT appealing. Show them that your office will be one to appeal over and over and they will deny less claims.
Elevate your front office: https://www.bonddentalconsulting.com/elevate-front-office
