The 5 most common claim denials and how to stop them in their tracks

Insurance claim denials are one of the biggest pain points for dental practices. They delay cash flow, increase administrative workload, and frustrate teams who are already stretched thin. The good news is that most claim denials are preventable with the right strategies.

This guide will walk you through the five most common reasons claims are denied—and actionable steps you can take to prevent them from derailing your revenue cycle. 

1. Missing or incomplete documentation

Insurance companies often deny claims due to missing documentation, such as diagnostic x-rays, narratives, or intraoral photos. Without the required proof of necessity, claims are flagged for additional information—or outright rejected.

Tips for prevention:

• Create an attachment checklist. Not sure where to start? Download Wisdom's dental billing cheat sheets for dental billing checklists and templates. 
• Cross-train your team. Ensure both clinical and administrative staff know the documentation requirements for common procedures.
• Pause before sending. Make it a habit to double-check claims for all required attachments before submitting.

2. Incorrect patient or insurance information

Claims with even minor errors in patient or insurance details—like a misspelled name, wrong date of birth, or outdated insurance plan—are often rejected outright.

Tips for prevention:

• Verify information upfront. Always confirm patient details and insurance eligibility before the appointment. Use digital tools to make the process faster and more reliable.
• Scan and store IDs. Keep copies of the patient’s insurance card and driver’s license on file for easy reference.
• Use a “garbage in, garbage out” mindset. Train staff to prioritize accuracy during data entry—errors caught upfront save hours of follow-up later.

3. Coordination of benefits (COB) issues

Claims involving multiple insurance plans are prone to denials if the primary and secondary insurers aren’t properly coordinated. Confusion about which payer is responsible for what portion can cause significant delays.

Tips for prevention:

• Ask the right questions. At every patient visit, confirm whether they have multiple insurance plans and update their file accordingly.
• Submit to the primary insurer first. Always send claims to the primary plan before submitting to the secondary payer.
• Track coordination details. Use your software to document payer responsibilities to avoid future mistakes.

4. Lack of medical necessity

Many claims are denied because the procedure wasn’t deemed medically necessary—especially for treatments like scaling and root planing, crowns, and buildups.

Tips for prevention:

• Document, document, document. Ensure your clinical notes clearly outline why the procedure was required. For example: For crowns, detail the extent of decay or damage (e.g., “50% of tooth structure compromised”). For SRP, include evidence of bone loss, pocket depths, and bleeding points from periodontal charting.
• Be specific in narratives. Generic phrases like “crown required due to decay” won’t cut it. Provide precise details, such as the location and severity of decay.
• Invest in intraoral cameras. High-quality photos can help demonstrate necessity more effectively than X-rays alone.

5. Timely filing issues

Every insurance company has a deadline for submitting claims—often between 90 and 180 days from the date of service. Submitting late is one of the easiest ways to guarantee a denial.

Tips for prevention:

• Track filing deadlines. Maintain a list of filing deadlines for each insurer your practice works with.
• Run daily and weekly checks. Use your practice management software to identify claims that haven’t been sent. Address them before deadlines pass.
• Submit electronically. Digital submissions are faster and provide tracking information to confirm receipt.

Bonus: Pro tips to stop denials before they happen

In addition to addressing the specific causes of denials, here are some additional strategies to reduce your denial rate:

• Monitor rejections daily: Rejected claims often include feedback that can help you avoid future mistakes. Check your clearinghouse daily to resolve rejections quickly.
• Track trends: Review denials monthly to identify recurring issues. Is one payer rejecting more claims? Are specific codes causing problems?
• Hold team reviews: Meet regularly with your clinical and administrative staff to discuss denial patterns and update protocols.

The impact of stopping denials

Preventing claim denials is about more than reducing frustration. It’s about improving your practice’s financial health and giving your team time to focus on patient care. When claims are paid promptly, your cash flow improves, staff stress decreases, and your patients benefit from a smoother experience.

By identifying common pitfalls and implementing preventive measures, you can transform your billing process and keep your practice running smoothly.

If managing claims still feels overwhelming, Wisdom can help. From crafting clean claims to tracking denials, our team of experts ensures your revenue cycle stays on track—so you can focus on delivering exceptional patient care. Learn more about how Wisdom can give you back your peace of mind. 

Editor's note: This article originally appeared in DE Weekend, the newsletter that will elevate your Sunday mornings with practical and innovative practice management and clinical content from experts across the field. Subscribe here.