3 Key Steps To Get Your Medical Claims Paid Faster

Remember tug of war? Your team pulling as hard as possible to make the dangling middle string cross the line before the other team out-maneuvers you resulting in your teams’ demise! Medical insurance billing for dentistry can also feel like that, except the scene is that the cause of your patients’ oral difficulties stem from their medical condition and/or medication use… Maybe there was an injury and the oral cavity sustained trauma? Or, maybe intervention is required prior to surgery or chemotherapy treatment? Yet, when you bill medical insurance, there is a tug of war with you on one side and the insurance company on the other! Here are some tips to reduce the “pull” to get your claims paid faster.

Sequence Your Diagnosis Codes

Sequence your diagnosis codes correctly by telling your story backward. For instance, you see a patient that needs extractions, bone grafting, membrane and implants due to sustaining trauma in the anterior region. The first code will be the worst condition you will be treating them for, i.e. partial loss of teeth due to trauma class I. Then, we work on the why.

Say, this patient fainted while using the toilet and their mouth struck the tub as they went down. We will code the fall off the toilet with striking object due to syncope (fainting) in a single-family dwelling. Here is how it would look:

This is the story:  John Doe was in his Hover me to open tooltip single-family house, fainted while using the toilet, and struck his maxillary and mandibular arches on the bathtub causing a partial loss of teeth due to trauma class I.

This is how the codes would be listed:

K08.411 – Partial loss of teeth due to trauma class I

W18.12XA – Fall from or off toilet with subsequent striking against object, initial encounter

R55 – Syncope

Y92.012 – Bathroom of single-family (private) house as the place of occurrence of the external cause

Does explaining your story both ways make sense? Medical billing for dentistry is all about making sense for each service line using up to four diagnosis codes.

Chart Notes

Chart note verbiage is incredibly important. No matter if you are submitting to dental or medical, make sure that your diagnosis codes match your SOAP notes (subjective, objective, assessment, plan). This documentation will support the diagnosis codes and is an area that needs continual reinforcement. When our doctors were in dental school, they wrote volumes of chart notes! But, now that they are in private practice, we are seeing text messages–and some of them are so cryptic and illegible. The best practice is actually something in between the two. All while remembering that the more you use the word “teeth”, the more medical will say that your practice is focusing on the dental issue. Instead, bring to light the stabilization of the bone or reconstruction of the maxillary or mandibular arches along with the causality of the assessment.

Here is a sample for a chart note for bruxism:

Chart Note Example

[su_note note_color=”#4fa0ca” text_color=”#ffffff” radius=”5″]

Jane Smith DOB – 12/27/55

Exam Date – 3/19/19

Chief complaint: Patient awoke to jaw pain approximately 3 days ago and feels like somehow her jaw is swollen.  No notation of any trauma to the area yet patient notes that she has had a shift in family dynamic with her in-laws moving in to live at her residence.  She states that getting used to other people in her house has not been easy.

Blood pressure is slightly elevated at 135/70 (bp taken at last recall appointment on 12/29/18 showed consistent with prior levels of 120/60).  Pulse was consistent with prior levels at 76. Patient states she has been taking 3-200mg Ibuprofen every 4 hours and does not feel that she has had relief.

Health History & Medication review:

Sinus problems – sinusitis (past)

Progesterone – menopause (current)

Estrogen – menopause (current)

Complete maxillary and mandible periodontal charting were taken along with a Previser risk assessment and a CBCT per doctors’ orders.

Health history review with Dr. Wells and the patient displayed that she is overall in good health with no prescription medication and only over the counter daily vitamins.  Dr. Wells notes that right mandibular is tender to touch and that patient has increased sensitivity to pressure.

Discussed with the patient that this is likely a jaw sprain due to increased stress causing sleep-related bruxism.  Treatment recommendations are to fabricate an appliance to reduce pressure on the right condyle.

The patient agreed with treatment and an impression was taken to fabricate the appliance.  The appliance was adjusted and delivered in 30 minutes.

NV – patient to be seen in approximately 4 weeks for follow-up adjustment.


Be clear, concise, and not repetitive. There is nothing more frustrating to medical insurance staffing than when we wear our dental hat and send everything… claim, periocharting, pano, bitewings, narrative, chart note, etc. You should be able to explain without any of that. If medical wants any additional documentation, they will ask for it. Additionally, if your procedure code description states “bone graft mandible”, you do not need a modifier telling them it was in the mandible.

For medical billing in dentistry, less is more.

Honesty is the Best Policy

Finally, be honest. Do not commit fraud just to get your claim paid. Insurance fraud is not a laughing matter and is punishable by jail, fines, and even a loss of license for your doctor. NO claim is worth that risk! Here are some of the key things that are considered fraud:

  • Billing for services not performed
  • Up Coding
  • Waiving co-payments and deductibles
  • Not disclosing payment from other insurance
  • Unbundling or improper use of codes


If you put these tips to use, they will help get your claims paid faster. But, if you are not billing medical, we encourage you to attend a course as soon as possible because you will be outmatched in tug of war. Just picture this, if it is you, alone, against the insurance company in a tug of war match, who would win? Getting the education and learning the rules will give you the “big guns” on your side of the rope!


Imagn Medical Billing Service

Due to the complex nature of medical insurance billing, most dental offices are not equipped with the knowledge to properly credential national payers, submit successful claims, or handle aging and appeals. Imagn Medical Billing Service performs the proper credentialing and billing for you, which results in fewer denials and time well saved as you rely on expert help.

One-Time Credential Fee

$795/per dentist

The key to more successful payments

Our experts complete the process so you can start billing medical insurance. Each dentist billing medical insurance needs to be credentialed.

Pay Per Case

Verification of Benefit

$35 per vob

We get your patient’s insurance information so you can set proper expectations with the patient regarding the specific coverage available and any out of pocket fees. This is the most critical step in all of medical billing.

Per Authorization

$40 per auth

All procedures require pre-authorization in order for your practice to get paid. Gaining appropriate authorization can be challenging, let our experts get the job done for you.

Claim Submission

8% of successful claim

You don’t have time to sit on hold. Let us sit on hold and handle the claim submission work for you  We also handle the aging and appeals so you can focus on your practice.

Choose Your Software

Imagn Software is your one stop solution with both medical billing and dental sleep medicine capabilities with world-class support

What most dentist don’t know is that medical billing can increase your case acceptance rate and ensure your patients get the care they need.

Imagn Software

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Our goal is to give you the best experience. But if you are not satisfied then we will give you a full refund for your software access fee within 30 days of purchase.

Add Imagn Sleep Software

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Our software provides everything you need

to give your patient’s the sleep care they deserve.

Patients can no longer afford to have dentists ignore the responsibility of providing care for sleep disorders. Two out of every three Americans report poor sleep; the ability to breathe well is the most important factor in determining a person’s sleep quality. 

Imagn Software Set-up Fee

$399 one-time fee

No contract and your satisfaction guaranteed.

Our goal is to give you the best experience. But if you are not satisfied then we will give you a full refund for your software access fee within 30 days of purchase.

Choose Your Monthly Devdent Support Program

In order for you to succeed, we offer a unique range of customer support solutions including coaching, online resources, implementation programming, and so much more. We keep an eye on the ever changing industry trends so you can focus on your practice

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The program to get and keep your staff trained.

Dental Sleep Medicine Support

$200 /month

The program to implement Dental Sleep Medicine into your practice.


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