Dental Claims Processing Whitepaper

Dental Claims Processing Best Practices for Converting Paper Claims to EDI in 837D Format

Executive Summary

Dental Claims Processing Whitepaper

While EDI has transformed dental claims processing to a streamlined, electronic endeavor, paper still represents approximately 20% of all claims submitted – and about 20% of those contain a dental x-ray that also needs to be processed with the claim. These ratios are not expected to change over the next 10 years.

Because processing paper claims is labor-intensive, many dental plans struggle processing them internally in a timely manner and without too much overhead. Other dental plans that outsource paper claims processing have issues with scanning x-rays and ensuring the security of their data (keeping data entry on-shore). In both cases, achieving claim-level accuracy of 98% or above, and processing them within 48 hours can also be challenging.

The purpose of this whitepaper is to identify the best practices that make processing paper dental claims faster, in a fully secure manner and with the highest degree of accuracy. These best practices break down into three categories:

  1. Overall process for processing paper dental claims and x-rays
  2. In-house claims processing and the use of OCR scanning software
  3. Outsourced claims processing and finding the right partner

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