How to reduce dental claim denial rates? It’s a question many practices ask, but no one gets the right answer. They are tired of dealing with claim denials which delay payments, decrease staff productivity, and affect the revenue cycle.
If you miss just one modifier, mention the wrong tooth number, or use an outdated CDT code, the payer denies a complete claim. And then you have to correct these mistakes, starting the claim submission process all over again.
But worry not. You can prevent these mistakes and save the time spent on rework.
Wondering how? That’s possible if you use a claim scrubbing software. It’s a tool that automatically catches billing errors before the payer receives and reviews a claim.
In this blog, we’ll guide you on how a claim scrubbing software works and what errors it catches to prevent claim denials, maximize reimbursements, and optimize dental RCM services for your practice. So, let’s discuss.
What is a Claim Scrubbing Software?
A claim scrubbing software reviews dental claims for errors, like typos, missing or incorrect details, and outdated CDT codes.
Using this software is important because payer policies and reimbursement rules change regularly, and the American Dental Association (ADA) updates CDT codes every year. Even an experienced billing coordinator can make mistakes and miss details while reviewing the fortieth claim of the day.
But that’s not an issue with a claim scrubbing software. It automatically checks each claim by running it through a library of sources, such as the ADA CDT coding standards, payer guidelines, and federal and state billing laws. If any field in the claim isn’t correct, the system immediately flags it and suggests corrections for your billing staff.
As a result, you can remove errors and submit clean claims before submission. It improves your first-pass claim acceptance rate, speeding up dental claim reimbursements and saving the time spent on appealing denied claims and rework.
How Does the Claim Scrubbing Process Work?
As we’ve discussed, claim scrubbing software improves the revenue cycle processes.
But the question looms: How does that happen? And you’ve got every right to ask this.
The answer is that claim scrubbing is a complete process that involves many steps. Let’s break down all these steps, so you get a clear picture of how things unfold.
Claim Creation
A dental claim is created in the practice management system or a billing software. A standard ADA dental claim form, or a form required by the payer, such as Aetna or Blue Cross Blue Shield’s custom form, is used for claim submission, and all the details are filled out, like:
- CDT codes
- Insurance plan data
- Procedure details
- Provider NPI
- Subscriber information
And supporting documents are attached, if required, like clinical narratives, dental radiographs, intraoral photos, and periodontal charts, or other evidence why the procedure is crucial for the patient’s health.
Patient and Insurance Data Checks
A claim scrubbing software, which is either a standalone tool or an in-built feature of a billing software, verifies all the details in the claim, like patient ID, date of birth, policy number, and provider NPI, by matching them with the patient data in the payer portal.
CDT Code Review
The software checks if the CDT codes in the claim form match the actual procedure and are accurate according to ADA’s latest code updates.
It’s possible when ADA’s latest coding updates are uploaded to the software, by exporting files, or integrating with payer portals. If the codes are outdated, retired, or incorrect, the software immediately flags them.
Payer Compliance Verification
The claim scrubbing software checks if all the CDT codes, fields, and documents fulfill the dental claim requirements for the payer.
Payer policies for each dental procedure are integrated into the system. Plus, each payer has its own requirements, and the software knows them and applies them correctly.
An example is that if the claim is being sent to Aetna, it checks that the claim complies with Aetna’s guidelines for claim submission.
If the claim is fully compliant, the software approves it, but if there are issues, it flags them and rejects the claim.
Real-Time Eligibility Verification
This one might be confusing because eligibility verification comes before claim scrubbing in a dental revenue cycle. But some modern tools integrate this process into claim scrubbing.
With that, a patient’s coverage plan is checked with available benefits and limitations in real-time. If you submit a complete claim but the patient’s plan doesn’t cover a treatment or covers just a part of it, the tool flags it as an error.
Error Reporting
Error reporting is a key step in the claim scrubbing process. When a claim scrubbing software verifies all the details in an insurance claim, it flags errors, whether these are mistakes in patient demographics, missing documents, or other issues.
It also flags low-quality documents, like clinical narratives, which are difficult to read, or radiographs with blurry images, which don’t properly show issues like caries, bone levels, or restorative margins. And it does it by matching them with payer requirements, which have defined image resolution levels for photos. It also uses artificial intelligence (AI) to detect other errors.
The tool produces a list of errors in the claim and recommends that the billing team correct them, and describes proper reasons for the errors, so your team doesn’t repeat the mistakes in future claims.
And if you use smart technology, like intelligent robotic process automation, it goes one step further by suggesting corrective actions, making the process easier for your staff.
Clean Claim Approval
When all the errors are resolved in a dental claim, the claim scrubbing software performs a final check and approves it for electronic submission. After that, it’s forwarded to a clearinghouse feature or software, which converts the claim into electronic form and submits it to the payer.
Note: While it seems lengthy on paper, the entire claim scrubbing process takes just seconds to complete.
What are the Common Billing Errors in Claim Scrubbing?
It’s important to know what’s behind most of the claim denials. In most cases, these are the same recurring mistakes.
The best dental billing software with claim scrubbing catches them all before a claim reaches the payer, ridding you of the inconvenience caused by managing denials. Let’s break down these in the table below:
| Billing Error | Description |
|---|---|
| Duplicate claim submissions | The same claim is accidentally submitted twice. |
| Exhausted frequency limitations | A procedure is billed that exceeds the payer coverage for a patient’s plan. |
| Higher fee charges | A claim is billed above the payer’s allowed amount for the procedure. |
| Incorrect or outdated CDT codes | A retired or incorrect CDT code is used for the procedure. |
| Incorrect provider NPI | A wrong or incomplete NPI is used for the provider. |
| Incomplete or missing tooth numbers | Specific tooth designations, like tooth number, tooth surface, or tooth system, are missed. |
| Missing attachments | Documents required by the payer are not attached to the claim form. |
| Missing pre-authorizations | A claim is submitted without a pre-authorization number and approval when payer approval is mandatory. |
| Patient eligibility issues | A claim is submitted for a patient whose coverage has ended or changed at the time of submission. |
| Unbundling procedure codes | Procedures that should be bundled and submitted together per payer policies are billed separately. |
This is the main benefit of claim scrubbing. It catches errors before submission, which is faster and cheaper than managing a denied claim.
What are the Key Features in a Claim Scrubbing Software?
While you’re deploying a claim scrubbing software, look out for the following features:
Comprehensive Payer Coverage
If you’re dealing with multiple payers, your software should add rules for every payer you bill.
Your tools shouldn’t be limited to insurance rules for nationwide commercial payers and state plans such as Aetna, Blue Cross Blue Shield, Cigna, Delta Dental, Humana, Medicaid, and United Healthcare.
Make sure your tool can automatically update these policies via integration, and if the payer changes its policies, these should instantly reflect in the tool. It’s a faster and more efficient process than manually updating payer rules, which takes a lot of time and is prone to errors.
Customized Workflow
A claim scrubbing software for revenue cycle management shouldn’t be a generic tool. It should allow you to set custom rules tailored to your practice’s processes and requirements.
For example, if claims for a certain procedure are repeatedly denied or a certain payer denies your claims, an ideal software lets you create checks based on these past patterns. So, the software adapts to the way you work.
Detailed Reporting
The software shouldn’t just scrub claims. It should also track data and provide analytics in real-time. For example, it may show you which claims mostly contain billing errors, what your clean claim rate is at the time, and which processes need improvement. With strong data, your staff knows how to improve their performance.
Integration with Tools
Your tool should integrate easily with your RCM automation and software. With that, your claim scrubbing software can easily connect with your practice management system and pull patient data and treatment records during claim scrubbing.
Make sure that the integration process is secure for HIPAA compliance, which requires patients’ health information to be accessed, stored, and shared securely. It also mandates that access should be limited to authorized staff members.
Real-Time Error Detection
The claim scrubbing software should check errors in real-time while submitting claims. And while it spots errors, it should immediately notify the billers of the reason for it. So, your staff knows the mistakes and avoids them in the future, making the claim scrubbing a smooth process.
User-Friendly Interface
The software should provide a dashboard that is easy for your billing staff to access. Error descriptions should be easy to read and understand, and it should be easy for staff to make corrections without thoroughly reading a manual every time.
What is the Impact of Claim Scrubbing on Dental Revenue Cycle?
Let’s discuss how using a claim scrubbing software improves your RCM accuracy.
Higher First-Pass Claim Acceptance Rate
When you detect errors on time with a claim scrubbing software, you can correct your dental claims before submission. Your claims are clean and compliant, convincing the payer to approve your claim. Most of the claims are likely approved by the payers on first submission, which improves your first-pass claim acceptance rate by 95% or even higher.
Controlled Accounts Receivable
When most claims are approved in the first submission, it means that payers reimburse claims faster, and you recover most of your payments. And that means a minimal amount remains unpaid. It reduces your accounts receivable, and you’re not busy trying to recover your due amount.
With strong claim scrubbing, practices reduce claim denials on average by 35% and reduce 60-70% A/R. It makes accounts receivable management smooth for your practice.
Reduced Overhead and Staff Burnout
If you manage dental billing manually, imagine how much time and effort it requires. A staff member:
- Reviews your claim denial
- Researches the reason
- Corrects the error
- Submits a claim again
It consumes a lot of energy, and you also need to spend a lot on hiring extra staff for claim scrubbing.
A claim scrubbing software reduces your overhead by automating the process. It prevents claim denials by detecting errors in just seconds, and allows your staff to focus on other important administrative and clinical tasks.
Your staff can also relax as they don’t have to get exhausted scrubbing each claim and managing denials.
How Does Claim Scrubbing Help You Stay Compliant?
As we’ve mentioned earlier, a reliable claim scrubbing software can automatically update payer rules over time. It integrates with your other tools or payer portals to update their requirements for claim submission.
It detects errors, so your staff can correct them and make them ready for submission. This helps with compliance.
It’s because when payers receive a huge number of claims with issues like upcoding or unbundling, they notice these patterns and might flag a practice.
This can affect your membership with an insurance company, while also resulting in regulatory risks with state authorities. If they suspect fraud, such as civil penalties or criminal charges, it may result in legal consequences.
And that’s where a claim scrubbing software helps. With real-time checks, there are no errors or claim denials. Clean and compliant claims protect your practice from regulatory issues.
Does Outsourcing Claim Scrubbing Optimize Revenue Cycle?
When you invest in a claim scrubbing software, it reduces your overhead and maximizes your return on investment (ROI).
But there are some issues to consider when you deploy the tool.
You need an IT expert’s support to deploy the tool and integrate it with your practice workflow. And, you also need resources to invest in the tool. The average monthly cost of a dental claim scrubbing software for small practices ranges between $100 and $500, which every practice may not be able to afford.
A cost-effective approach is to get the same level of services by partnering with an expert RCM services provider, like TransDental, which automates your claim scrubbing and manages these tasks efficiently. Such an RCM company knows payer rules very well and can handle these policies, providing customized services according to your revenue cycle trends and billing practices.
Your RCM outsourcing partner easily integrates with your existing software and also provides you with real-time insights.
A proven track record of reducing claim denials with an impressive first-pass claim acceptance rate justifies that a reliable outsourcing company uses effective outsourcing processes.
Plus, the costs of an RCM partnership are very reasonable. When you outsource your revenue cycle management, you get a complete package at a small percentage (not more than 4-5%) of your collections. And you don’t have to pay anything extra for claim scrubbing or invest in a separate tool dedicated to claim scrubbing! The error-checking feature is a part of the package.
It means they don’t just check errors. They correct these errors and submit claims that payers approve.
Are You Ready to Tackle Claim Denials?
If your practice is still leaning heavily on manual review, or if your denial rates are stubbornly higher than you’d like, it’s worth taking a serious look at how automated scrubbing can change that picture. The technology is accessible, the ROI is real, and the operational improvement makes your billing processes measurably better.
But, before you invest in a claim scrubbing software or use cost-effective dental RCM services, make sure that your vendor or partner:
- Offers you case studies or live demos of how errors are checked and corrected in the system
- Complies with all payer policy rules
It makes your dental claims clean and compliant, while your revenue cycle runs smoothly.
Frequently Asked Questions (FAQs)
How does claim scrubbing improve revenue cycle management?
It improves RCM by raising first-pass resolution rates, shortening accounts receivable timelines, reducing denial rates, and significantly cutting the cost and labor of reworking rejected claims across your billing cycle.
Does claim scrubbing software check patient eligibility?
Most modern solutions include real-time eligibility verification, confirming that a patient is covered on the date of service and that requested procedures fall within their plan’s active benefits before submission.
What is the difference between claim scrubbing and claim editing?
Claim scrubbing reviews claims for errors before they’re submitted, using automated rules to flag issues in real time so claims can be corrected on time. Claim editing involves correcting a claim after an error has already been identified, which means someone has already spent time tracking down the problem.
Does claim scrubbing software integrate with dental practice management systems?
Most leading solutions, like Dentrix, Eaglesoft, Open Dental, Curve Dental, and others, are capable of integrating. But you must consult with your vendor to confirm compatibility with your specific system before you commit. A reputable vendor walks you through the integration process during the evaluation stage and gives you a realistic timeline for go-live.
How often are payer rule sets in scrubbing software updated?
Reputable vendors update their rule libraries regularly, typically every month, with some offering near-real-time updates for major payer changes. Always ask vendors how their updates are delivered and whether they require any manual action on your end.
What should a dental practice look for in a billing partner that uses claim scrubbing?
Look for a partner that uses automated scrubbing as part of a comprehensive, end-to-end RCM workflow rather than as an isolated tool. They should be able to share their first-pass resolution rates, explain clearly how flagged errors are handled and corrected, and provide reporting that gives you ongoing visibility into your claims performance.
