Question 1

What is the difference between a rejected claim and a denied claim?

Accepted Answer

A rejected claim is stopped early because something in the submission does not pass the payer’s basic checks. That is usually an admin or formatting issue such as missing information, an invalid code, a mismatch in patient or policy details, or an attachment that did not transmit. The fix is typically to correct the data and resubmit so it can be processed.

A denied claim is a payer decision after the claim has been processed, shown on the EOB as not payable under the plan rules or based on the documentation received. The fix is different: you review the denial reason, confirm what the plan allows, and then either send supporting documentation, correct the claim if something was billed incorrectly, or appeal or resubmit as the payer allows.

Question 2

Can insurance verification prevent all claim denials?

Accepted Answer

No. Insurance verification helps reduce denials tied to eligibility and basic coverage issues, like lapsed policies, waiting periods, missing frequencies, or plan exclusions that are already visible before you submit. It also gives you a clearer picture of what information the payer is likely to want with the claim.

But it cannot prevent all denials or guarantee payment. Payers can still deny based on documentation, plan rules applied at processing, medical necessity, limitations that only show up on review, or how the claim is coded and supported. Verification is a strong starting point, not a final decision.

Question 3

What information does an outsourced biller need from my practice to reduce denials?

Accepted Answer

To reduce denials, an outsourced biller needs complete and consistent basics from your practice: patient demographics, the subscriber and plan details, eligibility information if you have it, accurate dates of service, the correct treating and billing provider details, and the procedure codes and tooth or surface information as recorded in the chart. They also need any prior authorisation or referral details when the plan requires them.

When a payer asks for more, the biller will need the supporting clinical documentation your team already has, such as narratives, perio charting, clinical notes, and any required images, plus a clear way to match those attachments to the claim. Clean inputs and a reliable documentation flow are usually what stop preventable rejections and denials.

Question 4

How are denied claims followed up and resubmitted?

Accepted Answer

Denied claims are tracked so they do not drop off the radar. We pull the denial reason from the payer response or EOB, then check the original claim details against what the payer says is missing or incorrect. If we need something from the practice, such as a narrative, perio charting, dates, or a corrected code entry, we request it through your agreed channel and wait for confirmation before we move.

Once the missing or incorrect item is resolved, we resubmit the claim with the corrected information and any required attachments, or file an appeal if the payer requires that route. Each touch is noted so you can see what was sent, when it was sent, and what the payer replied, then we keep following up until there is a clear outcome.

Question 5

Will you talk to patients about their balances?

Accepted Answer

Yes. As part of patient billing support, we can contact patients about balances based on your financial policies, answer straightforward billing questions in plain language, and follow up on overdue amounts. We keep notes aligned with the latest insurance activity so the account history stays consistent.

We do not discuss clinical matters. If a patient’s question is really about treatment, why something was done, or what is planned next, we flag it and route it back to your practice to handle.

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