What is a Dental Insurance Claim Audit?

insurance claims audit

Dental insurance can be confusing, and it’s important that you are billed for only what you get, and you are covered when it applies.  We keep track of everything through insurance claims auditing.

Here are the basics of insurance claims auditing:

Insurance Claims Audit for In-Network Dentists

Dentists are required to submit claims for any patient work. This allows us to offer coverage for dental work.

During this process, we review the claim to make sure that:

1. Your dentist did the work

2. Your benefits were applied correctly to the claim

Our dental insurance claims audit processes ensure our members are safe and our dentists are providing the best quality service to their patients.

For example, if x-rays from your dentist don’t match the work listed on the claim, our insurance consultants can request clinical notes or a narrative for verification.

A Secure Claims Audit Program Has a Paper Trail

We collect all relevant information from the dentist through email or mail. We don’t generally conduct a dental insurance claims audit over the telephone because it’s important to have a paper trail for consistent documentation. This process ensures your benefits are always being used correctly!

Your Explanation of Benefits Letter + Our Claims Audit Program

We process the claims by comparing it to your benefits package. This is where your EOB, or explanation of benefits, comes into play. Remember that piece of mail that comes after going to the dentist? It reads, “This Is Not A Bill,” in bold letters across the top. It’s the breakdown of what services your dentist submitted for you.

You shouldn’t have to take any action when you receive an EOB unless you:

  • Did not have the services done.
  • Something looks to be incorrect from what you recall during the treatment.

If you ever feel that there has been an error or something was processed incorrectly, contact us.


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