Tracking Unpaid or Denied Claims: A Dental Billing Guide to Faster Reimbursements
Keywords: dental billing, unpaid dental claims, denied dental claims, dental insurance claims, dental coders, dental billing training, American Dental Coders Association
Efficient revenue cycle management is the heartbeat of any successful dental practice. Among the most common bottlenecks? Unpaid or denied claims.
If you’re a dental biller, coder, or office manager, knowing how to track, analyze, and resolve unpaid or denied claims can make or break your practice’s cash flow.
In this guide, we’ll explore:
- Why dental claims get denied or delayed
- Proven strategies for tracking and managing unpaid claims
- Tools and workflows that simplify the follow-up process
- Where to get certified training through the American Dental Coders Association (ADCA)
🚩 What Are Unpaid or Denied Dental Claims?
Before we talk strategy, let’s clarify the difference:
- Unpaid Claims: Claims submitted to insurance that have not been reimbursed—possibly due to processing delays or missing information.
- Denied Claims: Claims that have been reviewed and rejected by the insurance provider for reasons like coding errors, lack of documentation, or eligibility issues.
Both types cost your practice time and money.
🔍 Top Reasons Dental Claims Go Unpaid or Denied
Knowing the most common causes can help you prevent them upfront. Here’s what to watch for:
- Incorrect or Incomplete Patient Information
Missing date of birth, policy number, or subscriber ID - Coding Errors
Misused CDT codes or outdated modifiers - Lack of Documentation
No supporting x-rays, perio charting, or narrative for procedures - Eligibility Issues
Patient wasn’t covered on the date of service - Frequency Limitations
Cleaning billed more than the plan allows - Timely Filing Errors
Claim submitted after the deadline
Avoid these pitfalls by investing in professional training like the
Certified Dental Billing Specialist (CDBS) and
Certified Dental Coder (CDC) courses from the
ADCA.
🧭 How to Track Unpaid or Denied Claims Efficiently
1. Use a Dedicated Claims Aging Report
Every dental software system should have an Aging Report—a critical tool for tracking claims over time.
Break it down by:
- 30 days outstanding
- 60 days
- 90+ days
Tip: Focus on claims older than 30 days. That’s when a red flag should go up.
2. Set a Weekly Claims Review Schedule
Block out time once a week to:
- Run your aging report
- Investigate claims stuck in limbo
- Prioritize high-dollar or time-sensitive claims
3. Categorize Denials by Reason
Track patterns by using a denial reason log. Categories might include:
- Code mismatch
- Missing documentation
- Patient ineligibility
- Non-covered services
This lets you spot trends and improve processes.
🔄 Best Practices for Resolving Denied or Delayed Claims
1. Verify Insurance Eligibility Before the Appointment
Use online portals or call the insurance company to:
- Confirm benefits
- Note frequencies
- Record plan exclusions
2. Double-Check Coding Accuracy
CDT codes are frequently updated. Use the most current version and apply proper modifiers.
Need help staying current? The
Certified Dental Coder (CDC) program helps coders master the nuances of dental coding.
3. Attach All Required Documentation
For common procedures like crowns or scaling and root planing:
- Include clinical notes
- Submit radiographs or perio charting
- Add a well-written narrative
4. Follow Up Like Clockwork
Create a claims follow-up checklist:
- Day 1: Submit claim
- Day 14: Call if no EOB received
- Day 30+: Resubmit or appeal if denied
Many practices have a backlog of claims simply because no one followed up. Don’t let that be you.
📋 Create a Claims Follow-Up Workflow
| Step | Task | Tool |
|---|---|---|
| 1 | Submit claim with all documentation | Practice management software |
| 2 | Track claim in aging report | Daily/weekly review |
| 3 | Check for EOB or denial code | Insurance portal or mail |
| 4 | Call for clarification | Use script with patient info handy |
| 5 | Resubmit or appeal with corrections | Attach additional documents |
| 6 | Update notes | Use internal notes for future reference |
🛠️ Tools That Make Tracking Claims Easier
- Practice Management Software (Dentrix, Eaglesoft, Open Dental)
- Excel or Google Sheets
- Insurance Portals
- Dedicated Billing Platforms (e.g., DentalXChange, Vyne Dental)
📈 Metrics to Monitor for Claims Performance
Track these KPIs monthly:
- Days in A/R (Accounts Receivable)
- First-pass resolution rate
- Denied claims percentage
- Appeal success rate
- Claims over 90 days
If these numbers are off, your billing workflow needs improvement—and the solution could be professional training.
🎓 Learn More: Get Certified in Dental Billing & Coding
Dental billing and coding can be complex. That’s why the
American Dental Coders Association (ADCA) created two comprehensive online classes designed to help dental teams succeed:
- Certified Dental Billing Specialist (CDBS): Master insurance claims, aging reports, appeals, and insurance laws.
- Certified Dental Coder (CDC): Learn coding accuracy, CDT updates, documentation best practices, and more.
Want to explore both paths? Visit the ADCA Education Page to find the right class for your career goals.
🧠 Final Thoughts: Take Control of Your Claims Process
Tracking unpaid or denied claims isn’t just about fixing problems—it’s about building a system that prevents them.
- ✅ Review your aging report weekly
- ✅ Categorize and track denials
- ✅ Follow up promptly
- ✅ Get the training you need to prevent future issues
With strong workflows, modern tools, and support from trusted education providers like the
American Dental Coders Association (ADCA), you’ll gain confidence, reduce errors, and increase practice revenue.
Ready to become the billing expert your office needs?
Enroll in the
Certified Dental Billing Specialist (CDBS) or
Certified Dental Coder (CDC) online programs today!
