Dealing with Dental Insurance Consultants-Documentation

When you're submitting claims/pre-d's for periodontal procedures such as scaling and root planing, osseous, grafts, you will clinically need both charting and raiographs However, you may not have to submit both. Some companies will require either radiographs or charting for periodontal procedures but not both. Check with the various carrriers you submit to to find out what they need. Don't submit more than you have to.

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Dealing with Dental Insurance Consultants

So, that’s the big secret in dealing with dental consultants. Submit clear concise appropriate documentation with your claims and pre-determinations. And if you do, you shouldn’t have trouble with claims being delayed.

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Dealing with Dental Insurance Consultants-Documentation

Many companies will require a pathology report before allowing benefits for a biopsy.

And they frown on paying for cystectomies for every 3rd molar that's extracted or apicoectomy

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Dealing with Dental Insurance Consultants

Most insurance companies will need to see recent full arch films for implants and removable/fixed prosthesis to determine if an alternate benefit is appropriate. But some will accept a "toothmap" in lieu of radiographs. To avoid submitting unneccessary documentation, check with a patient's carrier.

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Dealing with Dental Insurance Consultants-Documentation

There are times when the diagnostic quality of the radiograph is questionable. A good rule is to never submit any radiographs that you would not be hesitant to present to your study group.

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Visit us at The Huskin Group about our dental insurance and practice management services.

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