If you operate a dental service organization, you know claim denials aren’t just frustrating, they mean bottlenecks in cash flow, inflated administrative workloads, and reduced dental practice revenue.
Fortunately, smart, automated Revenue Cycle Management (RCM) tools can reduce claim denials by streamlining processes, improving accuracy, employing dental billing automation tools, and identifying problems—before they cause problems.
Why Are Dental Claims Often Denied?
Dental claim denials can stem from a wide range of issues that are preventable with dental RCM tools. Some of the most common reasons for dental claim denials can be found below:
- Eligibility issues: Failing to conduct proper dental insurance verification before treatment often results in denied claims due to the patient not being eligible.
- Missing documentation: Claims that lack required attachments, such as radiographs or clinical notes, are more likely to be rejected.
- Coding mismatches: Inaccurate dental billing and coding can lead to discrepancies that result in claim rejections.
- Missed deadlines: Most insurers have strict filing windows, with delays in submission often leading to denials.
The Impact of Claim Denials for Multi-Location DSOs
Multi-location DSOs face significant challenges when managing dental claim denials. For example, working with multiple providers, software systems, and billing teams can cause communication breakdowns and inconsistent processes, raising the risk of claim denials.
These denials can create the following problems for multi-location DSOs:
- Slower cash flow: Each denied claim delays reimbursement, slowing cash flow and negatively impacting financial stability for the dental office and your DSO.
- Increased admin hours: When claims are denied, your administration team will have to spend more time on rework and appeals. This time reduces efficiency and could result in higher labor costs.
- Higher accounts receivable days: The longer a claim stays unresolved, the more it increases accounts receivable days.
4 RCM Features That Prevent Dental Claim Denials
Dental RCM solutions like RevGen are designed to cut denials in half by preventing errors and streamlining the entire claims process from verification to submission.
Here are the top ways dental RCM services can help reduce claim denials:
1. Real-Time Eligibility Checks
A RCM solution should offer real-time eligibility verification, as it ensures insurance coverage is confirmed before treatment begins, eliminating one of the top causes of dental insurance denials.
This type of dental billing software performs automated checks that flag problems immediately, giving your staff time to correct the issue before a claim is denied due to an eligibility issue.
2. Fast, Accurate Claim Submission
Submitting claims within 48 hours of treatment greatly reduces delays and increases approval rates. However, when a team is swamped with claims, it can be difficult to submit those claims within that time frame. Having to submit multiple claims on a time crunch also raises the risk of errors.
A solution like RevGen solves this issue with automated claim processing and a team of RCM experts who ensure claims are submitted within the 48-hour window. The software also helps prevent missing documents or errors, ensuring information is accurate and all supporting evidence is provided to the insurer.
3. Guided, Error-Resistant Workflows
Built-in checklists and guided workflows ensure consistency across locations. This standardization is supported by RCMs that offer shared spreadsheets and files, a centralized portal, and dental billing software for DSOs.
These RCM features standardize workflows and billing to reduce the risk of manual entry errors or omissions. Alongside reducing risk, RCMs help teams work smarter and more cohesively, increasing your team’s overall efficiency.
4. Proactive Rejection Resolution
Instead of waiting for problems to escalate, modern dental RCM tools continuously monitor and review claims. Frequent reviews allow recurring errors to be flagged and corrected before they cause a denial.
Correcting issues in a claim before they’re sent to the insurance provider ensures your team isn’t bogged down by multi-day claim reviews due to necessary adjustments following errors. Faster claim processing from an RCM solution also helps prevent issues from slowing down your cash flow.
How RCMs Keep Denied Claims from Becoming Lost Revenue
Even with robust prevention measures, some claims will still be denied. What separates high-performing DSOs is how they manage those denials after the fact. With an RCM solution, you can stop denied claims from becoming lost revenue by utilizing the following features:
Consistent claim monitoring
Claims shouldn’t be left unchecked for months. An RCM like RevGen will include built-in dental claim follow-up features that monitor outstanding clean claims every 30 days.
Regular monitoring ensures that no claims slip through the cracks, while also allowing your team to take timely action to resolve denials and recover owed payments.
Dedicated appeals handling
Denied claims don’t have to mean lost revenue—if your RCM partner has a built-in, proactive appeals process. The best dental RCM solutions, like RevGen, handle appeals end-to-end: reviewing insurer feedback, identifying the reason for denial, gathering additional documentation, and resubmitting the corrected claim.
This takes the burden off your admin staff while significantly increasing your chances of recovering payments. With expert appeals handling in place, what might have been written off as bad debt becomes recovered revenue—and a healthier bottom line.
Smarter tools for smarter growth
As DSOs expand, dental billing solutions must scale with them. RCM solutions like RevGen offer centralized reporting, automation, and expert support that evolve alongside the business.
Scalable dental RCM solutions help practices minimize growing pains, reduce manual overhead, and retain more revenue, even as operations become more complex. As a result, DSOs can focus on patient care and growth while maintaining tight control over finances as they scale.
Reduce Denials and Reclaim Revenue With RevGen
If you’d like to harness the power of an RCM solution to cut your denials in half, RevGen by Oryx has you covered. As an RCM solution backed by a team of RCM experts, RevGen reduces claims denials, frees up staff for other work, improves financial performance, and handles claims faster for patients and dental offices.
Ready to see what an RCM solution can do for your practice? Learn more about RevGen and schedule a demo today!
