Dental claim reviews are one of the most frustrating roadblocks for practices trying to maintain steady cash flow. Even when a claim is coded correctly and submitted on time, it can remain stuck in review for weeks, sometimes months, delaying reimbursement and creating uncertainty for both the office and the patient. Understanding why claims enter review status and how to prevent it is critical for protecting revenue and keeping operations running smoothly.
What Does “Claim in Review” Mean?
When a dental claim is placed in review, the insurance company has flagged it for additional evaluation before issuing payment. This may involve verifying patient eligibility, checking documentation, validating coding accuracy, or confirming policy coverage. During this period, no payment is released, and the claim is effectively frozen until the review is completed.
The Most Common Reasons Dental Claims Get Stuck
Incomplete or Missing Documentation
Claims that lack required attachments, narratives, X-rays, periodontal charts, or clinical notes are frequently placed into review. Insurers will not process the claim until all supporting information is provided.
Eligibility and Coverage Discrepancies
If patient coverage is unclear, terminated, or does not match the service date, the payer will delay the claim while verifying benefits. Even small eligibility errors can trigger lengthy reviews.
Coding and Fee Schedule Conflicts
Incorrect CDT codes, unbundled procedures, or mismatched fees often lead to manual review by the insurance carrier. These inconsistencies slow processing and increase the risk of partial payments or denials.
Frequency and Policy Limit Violations
When services exceed plan frequency limits or conflict with exclusions, insurance systems flag the claim for manual inspection instead of automatic payment.
Lack of Timely Follow-Ups
Many claims remain in review simply because no one follows up. Without consistent monitoring, claims can remain stalled indefinitely.
How Claim Reviews Hurt Practice Revenue
Each day a claim remains in review delays payment and increases the practice’s accounts receivable. Over time, this causes:
Cash flow instability
Higher administrative workload
Increased patient billing disputes
Greater risk of timely filing expiration
Reduced profitability
Unchecked review delays quietly erode revenue even when production remains strong.
How to Prevent Dental Claims from Getting Stuck
Strengthen Pre-Submission Checks
Verifying patient eligibility, coverage limitations, frequencies, and required documentation before submission prevents many reviews from occurring in the first place.
Ensure Coding Accuracy
Accurate CDT selection, proper modifiers, and alignment with payer guidelines reduce coding-related flags.
Attach Complete Clinical Documentation
Providing narratives, diagnostic images, and treatment notes at submission eliminates unnecessary back-and-forth with insurance carriers.
Monitor Claims Actively
Consistent claim tracking and follow-ups allow offices to respond quickly to payer requests and prevent prolonged delays.
Implement a Structured A/R Process
An organized accounts receivable workflow ensures claims in review are addressed promptly and do not accumulate unnoticed.
The Role of Professional Dental Billing Support
Many practices choose to partner with professional dental billing teams to manage claim submissions, documentation, coding accuracy, and payer communication. With dedicated oversight, claims are less likely to enter prolonged review, and reimbursements remain consistent and predictable.
By proactively addressing the causes of claim reviews, dental offices can significantly reduce delays, improve cash flow, and strengthen the financial health of the practice.
Conclusion
Claims stuck in review are not random events they are the result of preventable gaps in documentation, verification, coding, and follow-up. When dental practices identify and correct these issues, they gain faster payments, fewer denials, and smoother operations. Preventing review delays is one of the most powerful steps a practice can take to stabilize revenue and support long-term growth.
