Use Provider Tools for free real-time claims with digital attachments and pre-treatment estimates. The same principle applies to treatments that address cosmetic needs rather than dental disease. It’s just not a payable claim under the terms of the dental benefit contract.Įxample: If you provide treatment for erosion, there’s a good chance the claim cannot be paid because erosion is a common exclusion under most dental plans. In such cases, it’s important to understand that a recommended treatment may be perfectly appropriate. Some procedures are not covered under your patient's plan, no matter what documentation is submitted. Understand the difference between what is covered and what is needed If it is not, include a written narrative so that the dental consultant will understand the purpose of the crown. Help the dental consultant review your claimįor extensive or unusual services, what would you need to understand why a patient needs a particular treatment? Dental consultants cannot directly observe a patient’s condition, so let them know what cannot be seen on an x-ray and any special circumstances unique to your claim.Įxample: If you submit a claim for a crown that was placed to restore a tooth with a fractured cusp, be sure the fractured cusp is visible in the x-ray copy. With electronic claims submission, your claims are automatically edited for missing or invalid information before they are sent to carriers. Lack of sufficient information, especially the member’s ID number, is the most common reason for a delayed or denied claim. Include all patient information on claims

Your knowledge and expertise about dentistry will likely come across clearly if you remember that your audience is a dentist just like you. Anticipate what questions a dental consultant may have regarding a particular claim and provide the reason it should be paid.Įxample: If you replace a crown that is less than five years old, anticipate the obvious question and explain what event or circumstance made the replacement necessary.ĭental consultants are licensed dentists, who share your depth of knowledge about dental treatment and disease. Here are some suggestions to speed up claim payments.ĭental consultants look for reasons to approve your claims.

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