Dental Carrier Billing and Claims Follow-Up

Why each carrier needs its own approach

Every dental carrier accepts the same basic claim, the ADA claim form or its electronic version, the 837D. After that, the details differ. Each carrier has its own provider portal, its own way of receiving radiographs and narratives, its own pre-treatment estimate process and its own route for reconsiderations and appeals. Plans sold by the same carrier can also differ, with PPO, dental HMO, indemnity and self-funded employer plans all handled differently.

A billing team that treats every carrier the same tends to send the same avoidable mistakes over and over: attachments missing on a carrier that always asks for them, frequency limits checked against the wrong plan year, or an appeal sent to an address that only handles new claims. Working carrier by carrier keeps those mistakes visible so they can be fixed at the source.

What carrier billing includes

• Eligibility and benefits. Confirming coverage, plan type, network status, deductibles, annual maximums, frequency limits, waiting periods and downgrade rules before the appointment, through our Insurance Verification & Eligibility service.
• Claim submission. Sending claims electronically through your clearinghouse or the carrier’s portal, with radiographs, perio charts, intraoral photos and narratives attached when the procedure calls for them, through Dental Claims Management.
• Pre-treatment estimates. Submitting estimates for larger treatment plans so patients can see their likely share before they commit.
• Payment posting. Posting EOBs and ERAs line by line, applying contractual adjustments and flagging underpayments through Payment Posting.
• Follow-up. Working unpaid and pended claims by age, by phone and in the carrier portal, through Accounts Receivable (A/R) Management.
• Denials and appeals. Reading the denial reason, correcting what can be corrected and appealing what should be appealed, through Denial Management & Appeals.
• Credentialing. Joining and staying in each carrier’s network, including re-credentialing and EFT/ERA enrollment, through Dental Credentialing & Provider Enrollment.

Carriers we cover in detail

Each page below explains how billing and follow-up work for that carrier in general terms. Plan rules vary, so we always confirm details in the carrier’s current provider materials and your agreement.

• Delta Dental claims billing and follow-up: a national network of independent member companies, each serving its own states.
• MetLife dental claims billing and follow-up: PPO and other dental plans with a dedicated dentist portal.
• Cigna dental claims billing and follow-up: DPPO, dental HMO and indemnity plans with online reconsiderations.
• Aetna dental claims billing and follow-up: PPO, DMO and plans administered for third-party administrators.
• Guardian dental claims billing and follow-up: group dental plans with a self-service provider portal.
• UnitedHealthcare Dental claims billing and follow-up: commercial, Medicare Advantage and Medicaid dental plans on separate platforms.

Carriers by state

The carriers your patients carry depend partly on where your office is. Delta Dental is administered by a different member company in different states, and Medicaid dental programs use their own plans and administrators. Our service area pages cover the carrier landscape in Texas, Florida, California and New York.

How we track carrier performance

Because we work in your own practice management system, every claim note and posting is recorded there. Through Dental RCM Reporting & Revenue Analysis, we can show aging, denial reasons and payment patterns by carrier, which helps you see which carriers are slow, which denials keep coming back and where a fee schedule may need review.

Carrier names on this site are trademarks of their respective owners. Texas Solutions RCM is an independent dental revenue cycle management company and is not affiliated with, sponsored by or endorsed by any dental carrier.

Book a free consultation to talk through the carriers your practice bills and where claims tend to stall.