Prefiling of Fees

Prefiling of fees is the process by which dental providers proactively submit their current fee schedules to dental insurance carriers before claims are filed. This practice allows insurers to have the provider's established fees on record, which are then used during claims adjudication to determine billed amounts and, in some cases, to factor into usual, customary, and reasonable (UCR) fee calculations for the provider's geographic area. Prefiling is distinct from the fees listed on individual claims and represents the provider's standard charges across all procedure codes.

The importance of prefiling fees is often underestimated by dental practices. Insurance carriers that maintain outdated fee information for a provider may process claims based on stale data, potentially resulting in lower reimbursements. When a practice raises its fees but does not notify carriers through the prefiling process, there can be a lag between when the new fees take effect internally and when they are reflected in carrier systems. This disconnect can lead to underpayments and confusion when EOBs show allowed amounts based on previously filed, lower fees.

Revenue cycle teams should note that dental practices should establish an annual process for reviewing and updating their prefiled fee schedules with all contracted and non-contracted carriers. This update should coincide with the practice's annual fee schedule review, which ideally considers current percentile data, overhead costs, and regional market benchmarks. Many carriers accept fee schedule updates through their online provider portals or through electronic data interchange (EDI) transactions. Maintaining documentation of when fees were filed and with which carriers creates an audit trail that supports any future reimbursement disputes.