🇦🇺Australia

Claim Denial Risks

2 verified sources

Definition

Practices must verify active policy, coverage, deductibles before work; pre-auth estimates coverage but changes can deny payment later. SA schemes reject claims for non-eligible clients or expired forms.

Key Findings

  • Financial Impact: AUD 500-5,000 per denied major procedure claim; 6-week SA claim processing window
  • Frequency: Per uninsured or policy-changed patient undergoing major work
  • Root Cause: Manual eligibility checks and non-guaranteed pre-auth approvals

Why This Matters

The Pitch: Dentists waste AUD 500-2,000 per denied claim from pre-auth gaps. Automated verification ensures 100% approval alignment before treatment.

Affected Stakeholders

Billing Staff, Dentists, Practice Owners

Deep Analysis (Premium)

Financial Impact

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Current Workarounds

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Prior Approval Delays

10-20 hours/month per practice on form handling and resubmissions; equivalent to AUD 1,000-2,000/month at AUD 100/hour dentist rate

Patient Treatment Delays

AUD 2,000-5,000 per lost implant case (avg implant revenue); 5-10% client churn from delays

Fines for Non-Compliance with Dental Regulations

AUD 5,000-50,000 per breach in fines and legal costs; 20-40 hours per audit preparation

Penalties for Using Non-TGA Approved Dental Devices

AUD 10,000-100,000 fines per violation; inventory write-offs of 5-10% stock value

Costs from Informed Consent and Record-Keeping Failures

AUD 5,000-30,000 per legal claim or compensation; 10-20 hours per incident documentation

Einnahmeverluste durch abgelehnte oder gekürzte Zahnleistungsansprüche wegen fehlerhafter CDT-Codierung

Quantified: Typischerweise 2–5 % des jährlichen Versicherungsumsatzes als nicht realisierte Erlöse; bei einem Praxisumsatz von AUD 1 Mio. entspricht dies etwa AUD 20.000–50.000 pro Jahr an verlorenen oder gekürzten Erstattungen.

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