Got questions? Send Ericka a Text!

Less than 1% of denied dental claims ever get appealed and insurance companies are counting on you to be in the other 99%. I walk you through the denial management mindset shift that changes everything: stop treating the third appeal like the edge of the map and start using the tools that actually hold payers accountable, including your state insurance commissioner for fully insured plans. 

We get practical and specific about what makes a denial “unreasonable” or “bad faith” and how to spot the pattern: benefits are active, eligibility is confirmed, documentation supports dental necessity, and the claim still comes back denied. I also explain why we start with state and federal laws before we obsess over codes, because language like prompt pay, network leasing, and silent PPO issues gives your conversations more weight. Then we clean up common risk areas by separating an honest mistake, a contract violation, and fraud, because mixing those up can put a practice in real trouble. 

From there, we talk tactics: why copy-and-paste appeal templates can work against you in a world where insurers use AI to review claims, and what to use instead. Think ICD-10 diagnosis codes, strong narratives, and patient-specific clinical details that make your claim defensible. Finally, I share documented enforcement examples, including a major fine tied to undisclosed “phantom” frequency limits, and why complaints to regulators compound over time. 

If you want a denial process that protects patients and stops leaving money on the table, listen all the way through, then subscribe, share this with your office team, and leave a review so more billers learn how to escalate the right way.

Sources referenced in this episode:

• Appeal rate / upheld rate: KFF analysis of CMS data — fewer than 1% of denied ACA marketplace claims are appealed; insurers uphold ~56% of appeals (2023 data), 66% (2024 data). Medicare Advantage: ~57% of appealed denials overturned. (On air we used these instead of the "59% upheld because nobody appealed" framing, which conflated the appeal rate with the uphold-on-appeal rate.)
• Delta Dental of Washington: Washington State Office of the Insurance Commissioner fined Delta Dental + its health care benefits manager (Wyssta) $130,000 (Oct/Nov 2024) for, among other things, denying claims based on time/frequency limits not filed with or approved by the state; 7 service types and 50 billing codes had undisclosed limits. Triggered by consumer complaints. This is an actual regulatory fine.
• Self-funded vs. fully insured (the "federal path" mention): The commissioner regulates fully insured plans. Self-funded employer plans fall under federal ERISA law and route to the U.S. Department of Labor (EBSA) instead, not the state commissioner. This is covered in depth in the full denial management talk, not this episode. (Government and church plans are a further exception.)
• Cigna PxDx: 2023 class action (E.D. Cal.), citing ProPublica reporting — ~300,000 denials in two months, avg. 1.2 seconds per claim, "we literally click and submit." Court allowed the case to proceed March 2025 (abuse of discretion). This is litigation, not a fine — described on air as a lawsuit/court ruling.
• UnitedHealth nH Predict: Class action (D. Minn.) alleging a 90% error rate on the AI tool and that ~0.2% of policyholders appeal. Court ordered algorithm disclosure in 2026. Allegations in active litigation — stated as such on air.
• The "0.2% will appeal" motive appears in both the Cigna and UnitedHealth complaints as an allegation of intent.

Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:

https://4063-dentiq.systeme.io/waitlist

Get your Dental Billing Toolkit Here:

https://www.dentalbillingdoneright.com/the-dental-billing-toolkit

Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:

https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header

Schedule a billing chat with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Email Ericka:
[email protected]

Email Jen:

[email protected]

Got questions? Send Ericka a Text!

Dental billing can look smooth from the outside, but that “smooth” is usually one person doing a mountain of detailed, high-stakes work behind the scenes. We’re sharing a quick, focused message about Dental Billers Appreciation Day and why it matters for every practice that depends on clean claims, accurate coding, and steady collections. 

You’ll hear how a conversation with Qiana Craig (Ask the Biller) about Medical Billers Appreciation Day sent us down a research rabbit hole and revealed something surprising: dental billers didn’t have a day of their own. So we created one. That story opens up a bigger theme we live by in dental office administration and practice management, if you don’t see the space you need, build it. 

We also get real about what the job requires: deep organisation, constant follow-up, tech skills across modern billing tools, and the discipline to keep up with changing codes and systems in today’s dental economy. Dental revenue cycle management doesn’t run on luck, it runs on expertise. Dental Billers Appreciation Day is July 20 every year, so mark your calendar and do something meaningful for the person who helps keep your practice financially healthy. If this resonates, subscribe, share it with your team, and leave a review so more dental offices start giving billers the credit they’ve earned.

Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:

https://4063-dentiq.systeme.io/waitlist

Get your Dental Billing Toolkit Here:

https://www.dentalbillingdoneright.com/the-dental-billing-toolkit

Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:

https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header

Schedule a billing chat with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Email Ericka:
[email protected]

Email Jen:

[email protected]

Got questions? Send Ericka a Text!

Your insurance AR report is trying to tell you the truth, but most of us only glance at the total and walk away with more anxiety than clarity. I’m Erica Aguilar, and I’m breaking down how to read the story behind the numbers so you can tell, with real confidence, whether your dental billing department is performing well or quietly leaking time and money.

We start with the biggest mindset shift: dollars alone don’t equal performance. I’ll show you how to turn each insurance AR aging bucket into a percentage so you can compare month over month and spot patterns that individual claims can’t reveal. You’ll get clear dental billing KPIs and benchmarks, including what “healthy” looks like when 92% of your insurance money is paid within 30 days, and why a heavy 90+ day category should trigger curiosity, not panic. From there, we talk through the questions that uncover root causes like late claims, missing attachments, delayed clinical documentation, weak claim construction, and payers that keep pushing you past state prompt pay laws.

We also widen the lens beyond insurance AR. I explain why patient AR tells a different story, why the credit balance report can expose compliance issues and unclaimed property risk, how to trend denials by payer and CDT code, and how poor fee schedule maintenance can inflate write-offs and create bad patient balances. Then we get practical with the claims correction list, the simple tool that creates visibility where most practices have none.

If you want a concrete next step, I give you homework to pull your key reports, start tracking denial reasons, and implement the free claims correction list from the show notes. Subscribe, share this with your office manager or biller, and leave a review with one question you want your reports to answer next.

Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:

https://4063-dentiq.systeme.io/waitlist

Get your Dental Billing Toolkit Here:

https://www.dentalbillingdoneright.com/the-dental-billing-toolkit

Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:

https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header

Schedule a billing chat with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Email Ericka:
[email protected]

Email Jen:

[email protected]

Got questions? Send Ericka a Text!

I want to share something with you this week that I don't usually talk about.

For years, Jen and I carried an idea we couldn't shake. We knew dental billing better than almost anyone, and we kept saying the same thing to each other. Somebody needs to fix this. Eventually, we realized that somebody was us.

What followed was not a clean, easy story. We flew to Arizona and locked ourselves away to get everything out of our heads and onto paper. We sat across from one of the most respected people in dentistry and got advice that was brutal, the opposite of what I wanted to hear. We turned down money that was on the table because we wanted full control, no holdbacks. And there was a stretch where it got so quiet that someone close to us asked if we had given up.

I'll be honest with you. There was a moment I wondered if I'd made the wrong call.

In this week's episode, I'm taking you all the way behind the scenes. The offers we said no to, the advice that changed everything, the doubt I rarely admit out loud, and the moment a room full of dentists showed me it was all worth it. I'm documenting this whole journey on purpose, so that you can learn from it too.

Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:

https://4063-dentiq.systeme.io/waitlist

Get your Dental Billing Toolkit Here:

https://www.dentalbillingdoneright.com/the-dental-billing-toolkit

Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:

https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header

Schedule a billing chat with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Email Ericka:
[email protected]

Email Jen:

[email protected]

Got questions? Send Ericka a Text!

Twenty browser tabs. Constant timeouts. Portals that never match your workflow. If you’ve ever felt like dental billing is less about skill and more about surviving fragmentation, we’re saying the quiet part out loud and giving you a clearer path forward. Jen and I unpack the “command center” concept: the practical system that pulls critical billing knowledge out of sticky notes, personal notebooks, and one overwhelmed team member’s memory, then turns it into a shared, durable source of truth.

We talk through what actually belongs in that command center so a practice can run with consistency: credentialing and CAQH details, NPIs and tax IDs, portal access and payment methods, EOB and EFT storage, end-of-day reporting, and a structured billing meeting framework that gives the doctor real visibility beyond “what’s in the bank.” We also dig into the cultural side of billing performance, including why doctors often measure the wrong things, why billers feel personally attacked by questions that should be normal, and how simple structures like pre-meeting forms and situational reports change the tone and the outcomes.

Then we shift into what we’re building next. Insurance has used AI in claims adjudication for decades, and too many practices are still fighting denials with manual work, copied templates, and hours of chasing. We share what we’re beta testing now: an API-integrated billing command center designed to reduce the grind by automating pieces like EFT retrieval, eligibility, claim tracing, denial tracking, and appeal letter generation, so the biller can spend more time making decisions and less time hunting for data. If you want to see what it looks like, grab the link in the show notes, join the wait list, and book a quick demo, then subscribe, share, and leave a review so more practices can stop running billing on hard mode.

Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:

https://4063-dentiq.systeme.io/waitlist

Get your Dental Billing Toolkit Here:

https://www.dentalbillingdoneright.com/the-dental-billing-toolkit

Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:

https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header

Schedule a billing chat with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Email Ericka:
[email protected]

Email Jen:

[email protected]

Got questions? Send Ericka a Text!

A claim can be created in seconds, but a defensible claim takes verification and that difference can make or break your reimbursement. We start with a tough question: if a dental claim is a legal document, why are so many practices submitting claims before anyone confirms the clinical documentation actually supports what’s being billed? When speed becomes the priority, compliance and cash flow both take the hit.

We zoom in on the insurance reimbursement cycle and redefine where it truly begins: the moment treatment is rendered, not when the claim is submitted. From there, everything depends on the clinical record being complete and accessible, from notes and narratives to X-rays, intraoral photos, and periodontal charts. I explain why clinical documentation is defensive documentation, the record that speaks for the provider during audits, disputes, or fraud allegations, and why billing teams should measure what prevents claims from being created, not just what’s already aging.

Then we break down the claims correction list, a pre-aging visibility tool that tracks completed treatment that cannot enter the reimbursement cycle yet. Unlike insurance A/R, denial, and production reports, it exposes the invisible money sitting in limbo and helps you spot patterns like chronic delayed notes, repeated missing attachments, or workflow handoff gaps. You’ll leave with a simple seven day challenge to document every reason a claim cannot be created and use that data to build predictable billing outcomes.

Subscribe, share this with your office manager or lead biller, and leave a review if it helps. What’s the most common reason your claims get stuck before submission?

Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:

https://4063-dentiq.systeme.io/waitlist

Get your Dental Billing Toolkit Here:

https://www.dentalbillingdoneright.com/the-dental-billing-toolkit

Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:

https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header

Schedule a billing chat with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Email Ericka:
[email protected]

Email Jen:

[email protected]

Got questions? Send Ericka a Text!

You can have hardworking people and still have a billing department that feels like a black box. Claims get submitted, denials appear, balances age, and everyone assumes follow up is happening, but nobody can point to where the work actually stalls. We dig into the “workflow engine,” the third pillar of the Fortune Billing Department Framework, and show how visibility is the missing link between dental production and predictable collections.

We walk through the practical tools that turn vague frustration into clear data. The big one is the claims correction list, a simple but powerful way to track why claims are not moving through the insurance reimbursement cycle. Insurance aging reports tell you what is overdue, but the claims correction list tells you the real reasons: incomplete clinical notes, missing narratives, missing x rays, additional information requests, and repeat documentation gaps that create denial patterns. When you can name the bottleneck, you can train, coach, and fix the process instead of chasing balances.

From there, we layer in daily and monthly rhythms that keep the revenue cycle healthy: an end of day billing report that creates real time communication between the billing team and leadership, plus a monthly billing meeting where trends become strategy and decisions are made by facts instead of assumptions. We also talk about building a structured billing calendar with owners and deadlines so “I’ll get to it when I have time” stops costing you money.

If you want your dental billing workflow to run like a system, press play, then subscribe, share this with your office manager, and leave a quick review so more practices can build predictable billing outcomes. What is the number one thing you suspect is slowing your claims down?

Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:

https://4063-dentiq.systeme.io/waitlist

Get your Dental Billing Toolkit Here:

https://www.dentalbillingdoneright.com/the-dental-billing-toolkit

Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:

https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header

Schedule a billing chat with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Email Ericka:
[email protected]

Email Jen:

[email protected]

Got questions? Send Ericka a Text!

Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:

https://4063-dentiq.systeme.io/waitlist

Get your Dental Billing Toolkit Here:

https://www.dentalbillingdoneright.com/the-dental-billing-toolkit

Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:

https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header

Schedule a billing chat with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Email Ericka:
[email protected]

Email Jen:

[email protected]

Got questions? Send Ericka a Text!

Your billing should not feel like a surprise every month. When collections swing up and down, it’s rarely because “insurance is just hard” it’s usually because the foundation was never built correctly. I walk through the core projects I use to make dental billing predictable, measurable, and strong enough to support growth, not just survive the next slow week. 

We start where the money actually begins: UCR fee positioning. I explain why raising fees by a random percentage can backfire, how NDAS market percentile data helps you choose an intentional fee strategy, and how Fair Health can help you spot check codes using real claims trends. From there, we move into employer research so you stop signing PPO contracts based on guesswork and start aligning with the plans your patient base truly carries. Then we do the math most offices skip: fee schedule analysis that compares reimbursements to UCR and shows your real write off risk by procedure. 

Next, I zoom out into business model strategy: traditional in network PPO, a hybrid out of network approach with key plans, and the realities of fee for service based on local demographics and discretionary income. To make all this usable, I share how to build a billing command center, clean up practice management setup with clear write off and adjustment categories, and tighten procedure mapping and coding structure so compliance and revenue meet in the middle. If you want your dental revenue cycle to run on data instead of stress, hit play, then subscribe, share this with your office manager, and leave a review so more practices can build billing that actually gets paid.

Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:

https://4063-dentiq.systeme.io/waitlist

Get your Dental Billing Toolkit Here:

https://www.dentalbillingdoneright.com/the-dental-billing-toolkit

Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:

https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header

Schedule a billing chat with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Email Ericka:
[email protected]

Email Jen:

[email protected]

Got questions? Send Ericka a Text!

If your practice feels slammed but collections still don’t line up with production, that’s not “just insurance.” That’s a billing system problem, and it’s fixable. We walk through the exact framework we’ve used to help hundreds of dental offices and group practices streamline dental billing, reduce denial chaos, and create predictable cash flow without gatekeeping or overcomplicating the work.

We break billing down into six pillars that build on each other: foundation, roles, workflows, compliance, metrics, and growth. You’ll hear what “foundation” really means in a dental revenue cycle, including practice management software setup, accurate codes, mapped procedures, fee schedules that match payer contracts, and credentialing that prevents avoidable delays. We also share why every practice needs a billing command center, a single source of truth for portals, passwords, processes, and payer details, so the department doesn’t collapse when one person is out.

Then we move into role ownership and workflow engine design so claim follow-up, denial management, and old AR cleanup stop being optional. We talk about using simple project management tools to keep billing work on a calendar, why consistency is what drives consistent insurance collections and patient collections, and how compliance and documentation protect everything you’ve built. We close with the metrics that matter, like insurance AR over 60 days, write-offs, and collection percentages, plus the reality that clean reports aren’t always honest reports, and why a growth loop of training and auditing keeps your billing department future-proof.

Subscribe for the next six weeks of step-by-step dental billing structure, share this with your team, and leave a review telling us which pillar you want to fix first.

Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:

https://4063-dentiq.systeme.io/waitlist

Get your Dental Billing Toolkit Here:

https://www.dentalbillingdoneright.com/the-dental-billing-toolkit

Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:

https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=header

Schedule a billing chat with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min

Email Ericka:
[email protected]

Email Jen:

[email protected]