You’ve probably been there before. You, or someone on your staff, submitted a claim. You used the proper form, included all the required information, dotted the i’s and crossed the t’s — or so you thought — and yet for some reason your claim was rejected.

It’s frustrating, but it happens frequently. To help you avoid the needless exasperation and delays, here are the five most common reasons why claims are rejected.

The claim rejection hall of shame

  1. The enrollee ID is incorrect or missing. The enrollee ID is the key to all our electronic interactions and must be correct for our system to recognize it. Before you submit a claim, double-check the ID to ensure you didn’t miss, transpose or add an extra digit.
  2. The patient information was incorrect. Any incorrect subscriber information will lead to a rejection. Check carefully to ensure that names are spelled correctly and dates of birth are accurate.
  3. The patient was incorrectly submitted as a dependent. When you provide patient information, include dependent information only when the claim is for a dependent.
  4. The submitted CDT code was revised or deleted. The American Dental Association (ADA) updates its CDT procedure codes and nomenclature annually. For instance, the ADA’s 2021 updates include 28 new codes, four deletions and 11 revisions. Ensure that you stay on top of the latest updates and use the correct CDT codes.
  5. The claim was submitted more than once. So nice you submitted it twice? Duplicate claims are a common mistake. To help keep track of your claims and submissions, register for Delta Dental’s Provider Tools. Provider Tools gives you eligibility and benefits information, remaining maximum and deductible amounts, claim submissions with attachments, claim status and treatment history in real-time — and at no cost.

Rejected claims are aggravating, and having to wait for reimbursement can be stressful, particularly during the current coronavirus pandemic. By keeping an eye out for these common errors and taking advantage of Provider Tools, you can minimize rejections and maximize your time and profits.