> ## Documentation Index
> Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Submit clean claims

> The clean 837D: current-year CDT codes, tooth/surface/quadrant accuracy, attachments riding with the claim, narratives for the documentation-demanded procedures, and same-day rejection handling.

A **clean claim** is one accepted by the payer on first submission and adjudicated without a denial or a request for information. In dental that means three things a medical claim never carries: current-year CDT codes, accurate tooth-level anatomy, and the attachment already riding with the claim. A 95%+ clean claim rate is achievable, and it is mostly data discipline upstream of submission.

## Prerequisites

* Payer contract executed, dentist credentialed, effective dates known
* EDI enrollment approved for the payer
* Benefits verified and the breakdown saved; see [Verify eligibility](/guides/billing/verify-eligibility)
* Required preauthorization obtained and **captured in the structured field**; see [Get predeterminations](/guides/billing/get-predeterminations)
* Attachment workflow live; see [Dental attachments](/reference/edi/dental-attachments)

## The clean-claim checklist

Run before submission, ideally as automated scrubber edits rather than human review.

### Entity and provider data

* [ ] **Billing provider legal name** matches the payer's records exactly, same as the CP 575 and W-9
* [ ] **Billing provider NPI** is the correct entity's Type 2 in a multi-PC group
* [ ] **Tax ID** matches the enrollment
* [ ] **Taxonomy** matches what you enrolled and contracted with
* [ ] **Rendering dentist's NPI** is credentialed and linked to this group's contract
* [ ] **Service date is on or after** the later of contract effective date and the dentist's effective date
* [ ] After an acquisition, claims use the legally and contractually correct billing entity and TIN for the date of service. Do not assume the seller's billing identity transfers. See [Acquire a dental practice](/guides/growth/acquire-a-dental-practice)

### Patient and subscriber data

* [ ] Subscriber ID exactly as printed, including any alpha prefix
* [ ] Name matches the payer's record, using the legal name rather than a nickname
* [ ] Date of birth matches
* [ ] Relationship code correct
* [ ] Coordination of benefits reflected if there is other coverage, primacy established

### Clinical and coding data

* [ ] **CDT codes valid for the date of service.** The set changes every January 1, and a claim carrying a deleted code may reject.<sup>1</sup> See [CDT and the 837D](/reference/edi/cdt-and-837d)
* [ ] **Tooth number, surfaces, and quadrant or arch designation** present, accurate, and internally consistent. Check for a surface count that contradicts the procedure or anatomy that conflicts with the payer's history.
* [ ] **Attachment submitted with the claim**, with the NEA number or clearinghouse reference included for each procedure the payer routinely requires documentation for<sup>2</sup>
* [ ] **Narrative present** where the procedure requires one; see below
* [ ] **Predetermination or preauthorization number** in the claim where one exists
* [ ] **Orthodontic banding date and months remaining** on ortho claims
* [ ] Diagnosis codes where the payer requires them (Medicaid programs increasingly do)
* [ ] Charges consistent with the fee schedule

## The documentation-demanded procedures

Some procedures are adjudicated on their documentation everywhere, and a claim submitted without it buys a request-for-information cycle that costs weeks. Send it with the claim:

| Procedure class              | Payers expect                                                                                                                                                    |
| ---------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **Crowns**                   | Pre-op radiograph showing the tooth, plus a narrative: why a crown rather than a filling, existing restoration's age and condition, fracture or cusp involvement |
| **Scaling and root planing** | Full perio charting with pocket depths, plus radiographs showing bone loss                                                                                       |
| **Buildups**                 | Narrative establishing necessity separate from the crown because payers may treat routine crown preparation as bundled                                           |
| **Implants and bridges**     | Radiographs, plus extraction history where a missing tooth clause may apply                                                                                      |
| **Ortho**                    | Records per plan; banding date on the claim                                                                                                                      |

A narrative should contain clinical facts written by or confirmed with the dentist, including relevant dates, measurements, and findings. "Crown needed" is not enough. "Mesial-lingual cusp fracture, existing 12-year-old restoration undermined" supplies specific findings.

## Configure the scrubber

Scrubber rejections are free. Payer denials and information requests cost 30–60 days. Push everything you can into automated edits:

| Edit                                                          | Blocks                                                                |
| ------------------------------------------------------------- | --------------------------------------------------------------------- |
| **Attachment required and missing**                           | A high-value dental edit that prevents request-for-information cycles |
| **Preauth required (Medicaid/DHMO) and missing**              | Unappealable nonpayment                                               |
| Deleted or not-yet-effective CDT code for the date of service | January rejections                                                    |
| Tooth/surface/quadrant missing where the code requires it     | Front-end rejections                                                  |
| Surface count inconsistent with the procedure code            | Downcoding and rejections                                             |
| Rendering dentist not credentialed with this payer            | Enrollment denials                                                    |
| Service date before the dentist's effective date              | Same                                                                  |
| Taxonomy mismatch against enrollment                          | Mysterious denials                                                    |
| Charge below the contracted allowed amount                    | You cannot be paid more than you bill                                 |

<Tip>
  **Prefer structural edits to checklist items.** A scrubber edit works when your biller is out. A checklist item depends on a person having a good day.
</Tip>

## Handle rejections same-day

Two acknowledgments come back, and neither is a denial:

|                               | 999                            | 277CA                                                |
| ----------------------------- | ------------------------------ | ---------------------------------------------------- |
| **From**                      | Clearinghouse or payer         | Payer                                                |
| **Says**                      | Whether the file was valid X12 | Whether the claim was **accepted into adjudication** |
| **A rejection means**         | Format problem                 | The payer's front end refused the claim              |
| **Was anything adjudicated?** | No                             | No                                                   |
| **Appeal rights?**            | None                           | None because there is no adjudication to appeal      |

**A 277CA rejection is not a denial.** The payer did not adjudicate the claim. Correct the data and submit a new claim. Do not use a corrected-claim frequency code because there is no accepted claim in the payer's system to correct, and do not appeal the rejection.

Work rejections **first thing every morning**. They are the cheapest problems available and they age toward [timely filing limits](/guides/billing/beat-timely-filing).

## The eight causes of most first-claim failures

For a new group or a new payer, in order:

1. **Billing provider NPI not recognized** because EDI enrollment is incomplete
2. **Legal name mismatch** across the W-9, CP 575, NPPES, and the claim
3. **Taxonomy mismatch** with the enrollment
4. **Rendering dentist not credentialed** or not linked to the group contract
5. **Service date before the dentist's effective date**
6. **Subscriber ID wrong**, with transposed digits or a missing alpha prefix
7. **Missing attachment or preauthorization** on a procedure that required one
8. **Stale CDT code** after the January 1 rollover

Six of eight are **enrollment** problems. First-claim failures are usually enrollment failures wearing a billing costume. See [Set up EDI, ERA, and EFT](/guides/enrollment/set-up-edi-era-eft).

## Corrected claims

To fix a claim that was **adjudicated** (denied or paid incorrectly):

* Resubmit with the appropriate **claim frequency code**: 7 for replacement or 8 for void
* Reference the **original claim number**
* Correct only what needs correcting

Do not resubmit an adjudicated claim as a new original claim. It may deny as a duplicate under CARC 18 and consume time within the correction window. Before correcting the claim, check whether the apparent underpayment is a downgrade or frequency limit rather than a claim error. See [Bill dental claims](/guides/billing/run-the-dental-billing-cycle).

## Steps

<Steps>
  <Step title="Enter charges within one business day of the visit">
    Days in AR starts at charge entry.
  </Step>

  <Step title="Attach documentation at charge entry, not at rejection">
    The radiograph and narrative for every documentation-demanded procedure, referenced on the claim.
  </Step>

  <Step title="Run the scrubber and clear every edit">
    Every one. An overridden edit is a denial you chose.
  </Step>

  <Step title="Submit the batch daily" />

  <Step title="Check 999 and 277CA every morning" />

  <Step title="Work every rejection the same day" />

  <Step title="Run the unbilled encounter report daily and get it to zero">
    Any completed visit without a charge is revenue that may never exist.
  </Step>
</Steps>

## Verify it worked

* [ ] Clean claim rate 95%+
* [ ] Charges entered within one business day
* [ ] Attachments and narratives riding with initial claims, not chasing them
* [ ] Scrubber edits configured, including attachment-required and preauth-required
* [ ] CDT tables rolled and tested each January
* [ ] No edits routinely overridden
* [ ] Rejections worked same-day
* [ ] Unbilled encounters at zero daily
* [ ] Rejection causes tagged and trending down

## Common failure modes

| Failure                                  | Consequence                                             |
| ---------------------------------------- | ------------------------------------------------------- |
| Claim sent without the attachment        | A request-for-information cycle on every crown          |
| Wrong tooth or surface                   | History-mismatch flags; duplicate and frequency denials |
| Stale CDT codes in January               | A wave of rejections to start the year                  |
| Treating a 277CA rejection as a denial   | Wasted appeals; claim never resubmitted                 |
| Resubmitting an adjudicated claim as new | CARC 18 duplicate denial                                |
| "Correcting" a downgrade                 | Rework on a claim that adjudicated exactly as designed  |
| Overriding scrubber edits routinely      | Chosen denials                                          |
| Charge entry lag                         | Days in AR; timely filing risk                          |

## Sources

1. Claims must carry the CDT version in effect on the date of service; the code set updates every January 1. ADA News, [60 changes coming to CDT Code in 2026](https://adanews.ada.org/ada-news/2025/june/60-changes-coming-to-cdt-code-in-2026-1/); see [CDT & the 837D](/reference/edi/cdt-and-837d).
2. NEA FastAttach workflow: Vyne Dental, [FastAttach](https://vynedental.com/fastattach/); Open Dental, [claim attachments](https://www.opendental.com/manual/claimtabattach.html). The X12 275 standard replaces this workflow by May 2028. See [Dental attachments](/reference/edi/dental-attachments).