Claim Appeals
A Claim Appeal.
What is a formal written request to a dental insurance company asking them to reconsider a denied claim?
A standard paper form that is universally used by dental practices to submit physical claims to insurance carriers.
What is an ADA Dental Claim Form?
The denial reason on a claim when a provider submits it past the contractually agreed-upon deadline.
What is a Timely Filing Denial?
Failing to properly mark a submission as a "Corrected Claim" usually results in this specific system rejection/denial.
What is Duplicate Claim Denial?
This is what an insurance company does when they look at an existing or old claim for a second time to fix a mistake.
That is reprocessing a claim?
The timely filing for an "Aetna PA" claim appeal.
What is 60 days from date of denial?
"Horizon NJ" EDI claims processing time.
What is 28 Calendar Days?
Claims Timely filing for Amerihealth DC Medicaid.
What is 365 days from DOS?
Healthy Blue Kansas Medicaid Corrected Claim Timely Filing.
What is 365 Calendar Days from DOS?
This is the word used when the insurance company pays a dentist too much money on a claim and needs to get it back.
What is an overpayment?
The "Wellpoint WV" Medicaid Appeals Address.
What is PO BOX 1396 MILWAUKEE WI 53201?
The "Health Plan" Claims Address for members under 21.
What is PO BOX 795, Milwaukee, WI 53201?
Standard claims timely filing with a Primary EOB for Aetna PA.
What is 365 from DOS?
The primary purpose of a "Corrected Claim".
What is an update, change, or replace a previously submitted claim?
Horizon NJ Health timely filing for Reprocessing Requests.
What is 180 calendar days from DOS?
"Horizon NJ" appeal determination turnaround time.
What is 30 Calendar days?
This 10- Digit number is unique to every healthcare provider and must be included on all standard claims for indetification.
What is an NPI ( National Provider Identifier)?
When a member has dual coverage, this rule determines which plan must receive the claim first to prevent missing the initial filing window.
What is the Coordination of Benefits (COB) rule?
This specific number, found on the original claim, must be referenced on a corrected claim so the claim can be properly linked to the original submission.
What is Claim ID (EID) Number?
This is the document the insurance company sends out after a claim is reprocessed to show the new payment breakdown.
What is an EOB (Explanation of benefits) or remittance?
A specific type of letter that must accompany an appeal, clearly outlining the medical necessity or administrative justification for reversing a claim denial.
What is an Appeal Letter or Letter of Medical Necessity?
Dental claims utilize this specific five-character alphanumeric coding system starting with the letter "D", to outline services being billed.
What are CDT Codes(Current Dental Terminology)?
This is the Calendar date that represents the final date to submit a claim for date of service March 15, 2026 if the claim timely filing is 90 Calendar days from the date of service.
What is June 13, 2026?
When an insurance company retroactively takes back money it previously paid to a dental provider.
What is a recoupment?
If a system glitch at the insurance company causes thousands of dental claims to deny by mistake, the company will run this type of massive fix to repair them all at once.
What is a mass claim reprocessing?