The Clinical Team’s Role in Smooth Dental Insurance Claims: A Guide from EDBS
When it comes to dental insurance claims, many offices assume the burden lies solely with the front desk or billing team. But in reality, the clinical team plays a vital role in ensuring successful, timely claim submissions. Without complete and accurate documentation from the back office, claims can be delayed—or denied.
At EDBS Dental Billing Solutions LLC, we’ve seen firsthand how a few simple changes in the operatory can drastically improve claim approval rates. Here’s what your clinical team needs to know and do to ensure claims are ready from the start.
Essential Clinical Information for Common Claims
Crowns, Bridges, Dentures, Implant Crowns
- Pre-op x-rays are always required for claims and predeterminations.
- If it’s a replacement, insurers need to know:
- Was there a previous restoration?
- When was it placed? (Estimate if over 10 years ago.)
Replacing Missing Teeth
- Document the extraction date (or estimated date) if you plan to replace a missing tooth—even for new patients.
Scaling & Root Planing (SRP)
- Include:
- Length of appointment
- Use of anesthetic
- Full perio charting with probing depths and diagnosis (especially for Cigna and other picky plans)
Other Key Documentation Often Requested
To avoid delays, make it routine to include the following for applicable procedures:
- Tooth-specific clinical findings (e.g., fracture on #9, decay on #3)
- Clinical narratives (brief explanation of condition or trauma)
- Photos (for fractured teeth, trauma, implants, cosmetic exclusions)
- Implant details (placement date, healing notes, specialist involvement)
- Endo claims: Pre/post x-rays, symptoms, pulp testing (if applicable)
- Occlusal guards: Diagnosis of bruxism or TMJ symptoms
- Sedation/Anesthesia: Type, dosage, duration, and reason for use
Build It Into Your Workflow
The best way to manage this consistently?
Use clinical notes template.
Have the doctor and assistant sign off on every chart.
Templates ensure nothing’s forgotten and help create a systematic, repeatable approach—especially as insurance companies continue to raise their documentation standards.
Why It Matters for Billing
The front office doesn’t always know what happens in the operatory. And if you’re working with a remote biller like EDBS, we only have access to what’s entered in your clinical notes and PMS.
Without that information, we can’t submit a complete claim—and your revenue suffers.
Final Thought
Dental insurance is evolving. By training your clinical team to document thoroughly and routinely, you take a major step toward faster payments, fewer rejections, and less stress.
Need help setting up clinical templates or reviewing denied claims?
Reach out to EDBS Dental Billing Solutions—we’re here to support your practice.