Specialty billing
Dental Billing and Dental to Medical Cross-Coding
CDT coding, medical crossover for procedures medical plans should pay, and predetermination management.
The challenge
What makes dental billing different
Dental billing runs on its own code set, its own claim form and its own benefit structure, with annual maximums and frequency limitations that behave nothing like medical coverage. Practices that treat it as a variation of medical billing consistently underperform on it.
The larger missed opportunity is crossover. A meaningful share of what a dental practice does — surgical extractions, trauma, obstructive sleep apnoea appliances, biopsies, certain implant work — is payable by the patient medical plan, often at better rates and without touching the annual dental maximum. Most practices never bill it.
Why us
Why dental practices work with us
Specialty billing is not a marketing label for us. Coders and A/R staff are assigned by specialty, so the person on your account reads notes like yours every day.
Get a free assessment- CDT and CPT both handled in house, so crossover claims are not outsourced twice
- Medically necessary procedures identified and routed to the medical plan first
- Predeterminations submitted before treatment so the patient hears one number, once
- Annual maximums and frequency limits tracked before treatment planning, not after
Scope of work
What we handle for dental practices
The work below is specific to this specialty, not a generic billing checklist with the name swapped out.
CDT procedure coding
Dental procedures coded to the current CDT code set with the narrative support each payer expects.
Dental to medical crossover
Medically necessary procedures cross-coded and billed to the medical plan on the correct claim form.
Predetermination management
Pre-treatment estimates submitted and tracked so the patient financial conversation happens up front.
Oral and maxillofacial surgery
Surgical extractions, biopsies and trauma repair coded for the plan most likely to cover them.
Sleep apnoea appliances
Oral appliance therapy billed to medical benefits with the sleep study documentation required.
Benefit and maximum tracking
Remaining annual maximum, frequency limits and waiting periods checked before treatment is planned.
The Right Way difference
What we watch on dental claims
These are the details that separate a paid claim from an appealed one in dental. They are checked on every claim, not sampled.
- 01 Whether a procedure is medically necessary and therefore belongs on a medical claim first
- 02 Narrative and radiograph attachment requirements, which drive a large share of dental denials
- 03 Frequency limitations and waiting periods that vary substantially between dental plans
- 04 Coordination of benefits when a patient carries both dental and medical coverage
- 05 Correct claim form and code set for each destination, since mixing them guarantees rejection
0+
Years running revenue cycles for physician practices
0+
Providers billed for across every specialty we serve
0%
First-pass clean claim rate
0 days
Median days in accounts receivable
Questions
Dental billing questions
What practices in this specialty ask us most often before making a change.
Ask us something elseCommonly surgical extractions, biopsies, trauma-related treatment, certain implant cases with a medical indication, obstructive sleep apnoea appliances and some TMJ treatment. The test is medical necessity and documentation, not the procedure name alone.
Yes, and we recommend them for anything substantial. A predetermination turns an uncomfortable post-treatment billing conversation into a straightforward pre-treatment one, which improves both collection rates and patient trust.
In most cases yes. We have operated in the major dental platforms and, where cross-coding to medical is involved, we bridge into the medical claim workflow so you are not running two disconnected billing processes.
How it works
Getting started takes about a month
The same four steps whichever specialty you are in. No system migration and no gap in your cash flow.
-
01
Revenue assessment
We audit a sample of your claims, denials and aged A/R and show you what we found. Free, and yours to keep either way.
-
02
Scope and agreement
A written scope covering exactly which services we run, what it costs and what we are accountable for.
-
03
Access and onboarding
We set up inside your existing EHR and clearinghouse. Two to four weeks, run in parallel with your current process.
-
04
Live and reporting
We take over submission and follow-up, and you get monthly reporting you can actually act on.
Free consultation
Let us look at your dental claims
Send us a sample and we will tell you specifically what is being coded, denied or under-paid — and what it is worth to fix. Free, and yours to keep.