FYI

Dentist blog from Delta Dental

Tag: CDT codes (Page 2 of 2)

The top 5 reasons claims are rejected

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.

Reminder: CDT 2021 updates have arrived

The American Dental Association’s CDT procedure codes and nomenclature* have been updated for 2021. The CDT updates for 2021 include 28 new codes, four code deletions and 11 nomenclature and description revisions.

Please review our summary of changes and claims processing policies (PDF) and begin using CDT 2021 codes on claims for procedures provided on and after Jan. 1, 2021.

*CDT coding and nomenclature are the copyright and a trademark of the American Dental Association, all rights reserved.

Use teledentistry to assess patients while sheltering in place

In light of the American Dental Association’s recommendation to postpone elective care, please use teledentistry to assess patients for non-emergency consultations and emergency diagnoses.

Delta Dental will accept claims for teledentistry services. Please submit the claim for your patient interaction using the appropriate evaluation procedure code, such as D0140, D0170 or D0171. On a separate line, also submit teledentistry code D9995 for real-time interactions (synchronous) and D9996 for text, photo or other non-live interactions (asynchronous) D0170, D0171.

Fees for teledentistry (D9995 and D9996) are considered inclusive in overall patient management and are not billable to the patient. Standard dental policy will apply to the evaluation codes.

For more details, please visit our COVID-19 resources for dentists. Once again, thank you for the work you do and as you guard our collective health.

Take a look at CDT 2020 updates

The American Dental Association’s CDT procedure codes and nomenclature* have been updated for 2020. Changes include 37 new codes, six code deletions and several nomenclature and description revisions.

Please review our summary of changes and updated Delta Dental claims processing policies and begin using CDT 2020 codes on claims for procedures provided on and after Jan. 1, 2020.

*CDT coding and nomenclature are the copyright and a trademark of the American Dental Association, all rights reserved.

View the PDF summary of CDT 2020 changes.

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Use CDT 2018 codes on claims starting Jan. 1, 2018

The American Dental Association’s CDT procedure codes and nomenclature have been updated for 2018. Changes include 18 new codes, three code deletions and several nomenclature and description revisions.

Please review our summary of changes and applicable Delta Dental claims processing policies, and begin using CDT 2018 codes on claims for procedures provided on and after January 1, 2018.

CDT coding and nomenclature are the copyright and a trademark of the American Dental Association; all rights reserved.

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