Two denial patterns
CO-96 — non-covered service: a procedure billed to the dental plan that the dental plan excludes, when it should have gone to the medical plan.
CO-109 — not covered by this payer: the claim reached the wrong payer entirely. Each misrouted claim loses weeks, and some lose their filing window.
How we prevent them
- Medical and dental coverage both verified before treatment
- Crossover procedures routed to the correct plan first time
- Coding reviewed for the plan the claim is going to
- Coordination of benefits handled across medical and dental payers
- Rerouted claims tracked against each payer's filing deadline
Systems we work in
We work inside Open Dental and the other practice management systems dental offices use, alongside your existing clearinghouse.
When a dental procedure is billed to medical
Some procedures done in a dental office are medically necessary and belong on the patient's medical plan: oral surgery after trauma, biopsies, treatment of infections, sleep apnea appliances and some TMJ care. Medical plans expect a medical claim form with CPT and ICD-10 codes rather than CDT codes, and usually medical-necessity documentation. Cross-coding these correctly is what turns a non-covered dental claim into a payable medical one.