Home > Claims, Coding, Payment
Web Content Viewer
Web Content Viewer
Part I: Avoiding common dental claim rejections
July 30, 2020

This article is for dentists and oral surgeons caring for our members

Periodically, we’ll bring you important information to help you improve the way we work together . The table below explains some common reasons why claims are rejected. It shows the Provider Detail Advisory/Provider Voucher messages you’ll receive for each and best practices for how to resolve the problem.

When the rejection code and message is This means that And you should
U301: According to our records, we have already processed a claim for this service. Please check your records for a previous claim submission. We have more than one claim on file for this patient for this service.
  1. Review your Provider Vouchers or on-line Provider Detail Advisories to see if there was an original claim in which the allowance was applied to the member deductible or coinsurance. In this case, we consider the claim to have been paid.
  2. Review your records and see if you provided these services.
  3. If neither #1 or #2 apply, resubmit your claim and allow 30-45 days for our response.
  4. If you disagree with this denial, please call the Dental Provider Services Area for additional support at 1-800-882-1178, Option #3.
M020: The benefit dollar maximum has been reached. The member has spent all the available dollars for their policy You can bill the member up to the plan allowable fee for services until their new plan year
E240: Policy not active for the date of service. Please verify prefix and identification number and resubmit your claim. The member did not have insurance with us at time of service Confirm that you submitted the correct information on the claim. If the information was:
  • Incorrect: resubmit with the correct information.
  • Correct: speak with the member to confirm you have the correct information on file.

Resources

Log in for access to secure resources.

 Dental Blue Book()
 CDT Coding Guidelines()
 Sample Provider Detail Advisory
To verify claims payment and search for claims, refer to payspan.com.
To verify benefits, eligibility, and claim status, use an eTool like Dental Connect().

MPC_031120-1L-7