Dental vs. Medical — The Core Difference
If you remember nothing else about medical billing in dentistry, remember this one distinction. It explains almost every other difference between how dental and medical claims work.
In-Network vs. Out-of-Network
If you've never billed medical insurance before, this is the single most important thing to understand before you submit your first claim. It affects what gets paid, how much, and how fast.
Deductibles, Coinsurance & Out-of-Pocket Max
This is the part of medical billing that trips up dental teams the most — not because it's complicated, but because it works backwards from how dental insurance works. If you're used to thinking about dental maximums, you need to flip your instinct for medical.
Reading an Eligibility Check
An eligibility check tells you far more than the insurance card does, but only if you know what to look for. This article covers how to pull the information that actually matters before submitting a claim: plan type, and whether out-of-network benefits exist at all.
Coordination of Benefits
When a procedure has both a dental and a medical billing pathway, don't choose one or the other — bill both, in the right order. This is one of the most underused techniques in dental-to-medical billing, and it can meaningfully increase what a patient recovers even when the medical claim doesn't pay out directly.
Prior Authorization Basics
Prior authorization is one of the most misunderstood parts of medical billing, mostly because of what people assume it guarantees. This article covers what it actually confirms, what it doesn't, and the timing rule that matters most.
Prior Authorization & Appeals — Full Workflow
This builds on the basics covered in Prior Authorization Basics. That article covers what prior auth is and the timing rule that matters most (it has to happen before treatment). This one goes further: which services typically need it, how to track a request end to end, realistic timelines, and what to do when a claim gets denied anyway.
Gap Exceptions
If you're out-of-network with a payer and a patient has an HMO or EPO plan, a standard claim is likely to be denied outright — those plan types generally don't cover out-of-network care at all. A gap exception is the mechanism that can change that outcome. This article covers what it is, when it applies, and what actually determines whether one gets approved.
Reading a Denial
A denial isn't a dead end, but treating every denial the same way wastes time and can be discouraging for no reason. Before you resubmit anything, figure out which category the denial falls into. That determines what to actually do next.