Pathway of a Dental Claim
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
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
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