Pathway of a Dental Claim

Create an illustration depicting a dental office setting with dental claims paperwork, insurance documents, and a dental professional reviewing them, bright and informative.

Understanding the Pathway of a Dental Claim

Enhance your knowledge of dental claims with our comprehensive quiz! This quiz is designed for dental professionals looking to sharpen their understanding of the claim processing pathway.

10 engaging questions
Multiple choice and checkbox formats
Test your knowledge on insurance processes

10 Questions2 MinutesCreated by NavigatingDental65

What is the first step in the pathway of a Dental Claim

Claim generated with attachments and sent

Claim is processed

Payment Posted

Charges created and posted to the ledger

Before a final walkout is complete, you must review and insure the insurance is attached and the appointment should be ________ to capture all updates

Complete

Recalculated

Rescheduled

Processed

If an ADA claim is missing a tooth number for a dental code, the claim will probably be

Accepted and paid

Rejected at the clearinghouse

Caught thru scrubbing process

Sent to the insurance company to process

If you offer any discounts outside of your contracted agreements (set fee schedule), you must disclose what you intend to ________ and _______ to the insurance company

Bill

Collect

Not file

Attach

The clearinghouse will do the following for each claim:

Process and pay your dental claims

Provide an intense scrubbing of the claim to check for errors

Submit your dental claim electronically to the insurance co

Deny your dental claims

Adjudicate your claim

Track and provide history for claims as they are rejected or accepted by the insurance co.

Flag/pull claims that require x-rays, narratives, photos, and EOB before the claim is sent to the insurance co.

Insurance companies are required to process your claim within 30 days of acceptance of the claim

True

False

If an insurance company rejects the claim filing the claim will sit where?

Insurance co Inbox

In the mail

At the clearinghouse

In the trash

What does Adjudication mean?

Claim will be rejected until additional information is received

After insurance co receives an accepted claim they will begin to determine their financial responsibility for the payment of the claim

Ins will pay a claim

Ins will deny a claim

Once a claim has been adjudicated and processed the insurance co will create the following

A rejection

An approval

A denial

An EOB

Which of the following ALWAYS requires more information and MUST be corrected every time

Denials

Rejections

Approvals

Walkouts

Pathway of a Dental Claim

Understanding the Pathway of a Dental Claim

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