How a Dental Practice Recovered $86,000 in Written-Off Restorative Claims

The Dental Practice is a growing multi chair dental clinic with a heavy major restorative caseload. Crowns, endodontics and periodontal therapy made up a large share of production, and those are exactly the procedures payers scrutinise hardest.

The practice came to Luxen with a denial rate close to 19 percent and a stack of aged claims the team had stopped chasing. Nobody could say why the same procedures kept coming back. Luxen took over the full revenue cycle, starting with the aged accounts receivable and working back to the cause.

The challenge. Denials clustered almost entirely on major restorative work. Crown submissions were going out without pre-operative radiographs or a supporting narrative. Periodontal scaling claims were missing full mouth charting with pocket depths, which most payers require before they will pay above a prophylaxis. A smaller group of denials traced to frequency limitations and alternate benefit clauses that nobody was checking before treatment was scheduled.

The practical effect was that the team treated denials as inevitable. Appeals were filed only when someone had a spare hour, which meant most were not filed at all, and filing windows were quietly closing on money the practice had already earned.

What we did. We started with the aged accounts receivable, working the 90, 120 and 180 day buckets in order of recoverable value rather than age alone. Where documentation existed but had not been attached, we assembled and appealed. Where it did not, we told the practice plainly which claims were not worth chasing.

In parallel we rebuilt the front end. Radiographs and narratives are now attached at the point of submission rather than requested after a denial. Perio charting is verified before a scaling claim goes out. Benefits are checked ahead of the appointment, so frequency limitations and downgrade clauses surface while the treatment plan can still be discussed with the patient rather than after the claim is denied.

• $86,000 recovered from aged accounts receivable in the first four months
• Denial rate fell from 19 percent to 7 percent as the attachment workflow took hold
• Appeals now filed inside the payer window rather than when someone found time
• Treatment plan conversations happen before the claim, because coverage limits are known ahead of the appointment

The practice kept its practice management system, its payer contracts and its patient relationships throughout. Luxen worked inside all three. See how the process runs, or book a billing review and we will tell you what your own denial pattern looks like.