A Step-by-Step Guide to How Dental Offices Get Paid—and Where Things Can Go Wrong

Managing the financial side of a dental practice isn’t just about submitting claims—it’s about understanding the full lifecycle of a patient’s visit from the first appointment to final payment. The dental billing lifecycle is the process that ensures services rendered are translated into revenue collected.

Let’s break down the entire journey of dental billing so you can improve your cash flow, minimize errors, and get paid faster.

Step 1: Patient Scheduling and Pre-Visit Prep

It all starts with scheduling the appointment. But before a patient walks in the door, your team should:

• Collect insurance information

• Verify eligibility and benefits

• Identify pre-authorizations, if required

• Communicate estimated out-of-pocket costs

Why it matters: Early verification helps avoid denied claims, surprises for patients, and gaps in your revenue stream.

Step 2: Patient Check-In and Service Delivery

At the time of the appointment:

• Confirm patient demographics and insurance again

• Have them sign necessary consent forms

• Provide services and document everything accurately in the clinical notes

Why it matters: Accurate clinical documentation and proper CDT codes are essential for clean claim submission.

Step 3: Claim Creation and Submission

Once services are rendered, your billing team prepares and submits the claim:

• Use correct procedure codes, modifiers, and provider IDs

• Attach supporting documents or X-rays when needed

• Submit to primary and/or secondary insurers

Why it matters: Clean claims result in faster approvals and fewer rejections or delays.

Step 4: Insurance Adjudication

After submission, the insurance company reviews the claim to:

• Approve and pay, deny, or request more information

• Apply adjustments like allowed amounts, write-offs, or co-pays

• Issue an EOB (Explanation of Benefits) or ERA (Electronic Remittance Advice)

Why it matters: Monitoring this step ensures you’re aware of claim outcomes and can act quickly on denials or short payments.

Step 5: Payment Posting

Once the EOB or ERA is received:

• Payments are posted in your practice management system

• Adjustments and write-offs are recorded

• Any remaining balance is moved to patient responsibility

Why it matters: Proper posting ensures financial records are accurate and that you know what’s still owed.

Step 6: Patient Billing and Collection

After insurance pays their part, you’ll:

• Send clear, detailed patient statements

• Offer payment plans if needed

• Follow up on outstanding balances professionally and promptly

Why it matters: Timely patient billing keeps accounts current and improves your overall collections rate.

Step 7: A/R Follow-Up and Denial Management

Not every claim gets paid on the first try. Your team (or billing partner) should:

• Review and re-submit denied claims

• Appeal underpayments

• Follow up on aging accounts

Why it matters: Regular A/R cleanup prevents revenue leakage and helps keep your finances healthy.

Need Help Navigating the Full Dental Billing Cycle?

At Bridge The Gap Dental Solutions, we specialize in managing your billing from start to finish with accuracy, speed, and care. From claims to collections, we’re your trusted partner in practice growth.
Contact us today to learn how we can support your success.