The attachment was not there
Crowns, deep cleanings and other procedures need specific X-rays, perio charts or a written note. When one is missing, the insurer asks for more information and the payment waits.
For dental practices
Stop sending claims you already know will come back.
A check that runs on every claim before it leaves the office. It flags the missing X-ray, the missing note and the "already paid this year" limit while the fix still takes a minute.
One-time build · $5,000
90+ min
one dentist spent on the phone with an insurer over a single claim that had been denied three times.
Why dental claims come back
The plan limit was already used
Many plans pay for a procedure only once in a set period. If the patient had it done elsewhere, the claim is denied as "benefit maximum reached" even though nothing was coded wrong.
Software manualX12 claim adjustment reason code 119
Each insurer wants something different
Some insurers want the dates and areas of the earlier deep cleaning on a perio maintenance claim. Others do not. Nobody at the front desk can remember every rule.
Company blogDentistrySupport guide to dental claim narratives
How it works
Your rules, written down once
We list what your main insurers ask for, procedure by procedure. You can add to the list any time a claim comes back.
Every claim is checked
Before sending, each claim is compared with those rules and with the patient's history in your practice software.
Fix it before it goes
The front desk sees exactly what is missing on which claim, and a draft note built from the clinical record when a note is needed.
What you get
- Fewer claims returned asking for more information
- Frequency and waiting-period problems caught before the patient is billed
- A list of which rules cause the most returns, so the list gets better every month
- Less time on the phone with insurers
A good fit if
- Claims regularly come back for X-rays, notes or perio charts
- You do a lot of crowns, deep cleanings or perio maintenance
- You use Open Dental, which allows the direct connection this needs
Probably not for you if
- Your billing is outsourced to a service that already checks claims
- You use Dentrix and want it built into Dentrix itself, which Dentrix does not allow for claim tools
Price
$5,000
One time, for the finished tool. About 70–130 hours of work at the same $50 an hour as the cost calculators on this site.
Talk about your practice- Rules for your main insurers and most common procedures
- Connected to your practice software
- Draft notes built from the clinical record
- Training for the person who sends claims
Questions
What are the most common dental claim denial reasons?
Most denials come from a small set of causes: a missing attachment, a missing note, a plan limit already used, or a waiting period. Checking every claim against those before it is sent prevents the ones that are preventable.
Does it send claims for me?
No. It checks them. Your team still sends claims the way it does today.
Who keeps the insurer rules up to date?
The rules are a list your team can edit. When a claim comes back for a new reason, you add the rule so it is caught next time.
Does it work with Dentrix?
Dentrix does not allow outside tools for insurance claim processing through its official connection. For Dentrix offices it can work as a separate checklist from report exports. I will tell you honestly whether that is worth it for you.
More for dental practices: Insurance payment matching, Unpaid claims follow-up, Insurance plan decision, Coverage check sheet. Everything for dental practices
Further reading
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