Dental Insurance Hub: ADA assists with scaling and root planing claim submissions

Scaling and root planing some of most common procedures frequently denied reimbursement by payers

Editor’s note: Dental Insurance Hub is a series aimed to help dentists and their dental teams overcome dental insurance obstacles so they can focus on patient care.

Scaling and root planing are some of the most common procedures that are frequently denied reimbursement by payers, according to the ADA Council on Dental Benefit Programs.

To help dentists improve their scaling and root planing claims, the council developed and published a new online resource that offers both a long version and a short version of the Claims Submission: Scaling and Root Planing document. 

The documents help dentists better understand the different components a scaling and root planing claim should entail, including an overview of common concerns, information on recording attachment loss and periodontal charting.

The documents come in response to a growing number of reported questions to the ADA about the large number of denials, alternate benefits and requests for additional information from dental insurers related to scaling and root planing claim submissions.

The council sought a solution to understand the issues from both the dentist and payer perspectives in an effort to help dentists better submit scaling and root planing claims.

Ask any dental office team member that works on insurance claims and they will tell you that a major pain point is a claim that involves scaling and root planing,” said Mark Johnston, D.D.S., chair of the council’s Dental Benefit Information Subcommittee.

Periodontal scaling and root planing procedures tend to have a higher frequency for denial and/or requests for additional information from dental plans compared to many other claim submissions,” Dr. Johnston said.

Dr. Johnston said the documents were developed to provide thorough information and suggestions on how to help dental offices get these claims correctly adjudicated on the first submission. The documents also provide insight into the typical claim adjudication process for scaling and root planing claim submissions.

For further information on dental insurance, visit the ADA’s online dental insurance hub where you can find archived webinars, dental insurance guides, dental insurance FAQs and much more.