Specialty billing / Dental
Dental claims run on their own code set, their own claim form, and benefit structures built around annual maximums and frequency limits rather than medical necessity. Add attachments, waiting periods, and the constant question of whether a procedure should bill to dental or medical, and the administrative load per dollar collected is high.
0
Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
Where it breaks
Cleanings, exams, bitewings and full mouth series each carry benefit frequency rules measured from the date of the last service, sometimes by calendar year and sometimes by rolling months. Booking on the wrong interval turns a covered visit into patient balance.
Crowns, endodontics and periodontal procedures usually require radiographs, periodontal charting or a narrative before adjudication. Claims submitted without them are not denied so much as parked, and the aging clock keeps running.
Surgical extractions, biopsies, sleep appliances and trauma treatment are often covered under the patient's medical plan. Practices that only bill dental leave that revenue behind and burn the annual dental maximum on procedures medical would have paid.
A treatment plan that ignores the remaining annual maximum leaves the patient with a bill they did not expect. Sequencing phases across benefit years, when clinically appropriate, is a billing decision as much as a clinical one.
Frequently billed
Representative codes only. Actual coding follows current CPT/HCPCS guidance and payer policy.
Denials we prevent
FAQ
Medical plans commonly cover procedures with a medical basis: surgical extractions including impacted third molars, biopsies and lesion removal, treatment of trauma, temporomandibular disorders, and oral appliances for obstructive sleep apnea. Billing these to medical preserves the patient's dental annual maximum for restorative work.
A predetermination is a pre-service estimate from the plan showing what it expects to pay for proposed treatment. It is not a guarantee, but for crowns, bridges and periodontal surgery it converts a surprise balance into an informed decision. For high-value treatment plans, the wait is almost always worth it.
Usually because the plan is waiting on an attachment. Most carriers want a preoperative radiograph and often a narrative explaining the clinical reason a crown was needed rather than a restoration. Submitting these with the original claim, instead of after a request, removes the largest source of dental accounts receivable aging.
It depends on the plan. Some count by calendar year, meaning two cleanings any time within the year. Others count from the exact date of the last service, so a cleaning at eleven months is denied. Verifying which method a plan uses before scheduling recall prevents avoidable patient balances.
We work inside the system your team already uses rather than asking you to change platforms. Claims, attachments and posting happen in your software so your clinical and scheduling workflows stay intact, and your reporting stays consistent with your historical data.
Other specialties
Next step
Send us your specialty, claim volume and current billing setup. We will come back with a proposal you can act on.
