Dental claim narratives When sending dental claims, the most frequent errors are improper coding and a lack of details and attachments. A denied claim will result from billing an anterior composite code for a posterior tooth, however this error is completely preventable. Lack of information can cause the same delay as supplying erroneous information on a dental claim, which can be a headache. In this post, we wish to concentrate on the knowledge required to create persuasive dental claim narratives that prompt prompt payment from insurance companies.
Be mindful that a pre-written narrative template may end up raising a red signal for a claim examiner, whether you are sending the narrative on the front end or the back end. Continue reading for useful hints on creating persuasive dental claim narratives, as well as details on how to mail clean claims and challenge insurance denials.
Clinical records are essential.
Utilizing the doctor’s clinical notes provides the framework for creating dental claim narratives that are successful. The SOAP format is always advised to make sure that all pertinent data is recorded in a clinical note. What is meant by SOAP?
- Subjective — patient testimony
Objective: the dentist’s clinical observations
evaluation — the physician’s diagnosis is
Plan — the documented course of action
It’s important to remember that a predetermined explanation for every comparable claim may end up raising red flags for examiners and leading to an audit. It’s best practise to steer clear of template language when writing a narrative. For details on each service, consult the doctor’s clinical report; then, utilise that language in the narrative.
Crown-related dental claim information
The age of the current renovation is __ years.
The current restoration consists of: Filling____ Onlay_____ Crown___
Age at this time:
Clinical indications for replacing restoration include: Decay, Fracture, and Pain or a cracked tooth
Do you need restoration?
Is this where the crown was originally positioned? Yes ____ No_____
Initial placement date:
Is a different operation carried out on the day of the crown preparation (or on a different day before the appointment) to replace any missing or damaged tooth structure that will be required to support the new crown? The build-up is required to support a new crown in order to restore function because the massive, old, failed restoration had deteriorated and destroyed the supporting tooth structure.
Send a bitewing x-ray, an intraoral photo, and a current periapical x-ray with the apex after any decay or previous restorations have been removed.
For a multiple surface composite restoration, the dental claim narrative
What restorations already exist?
Current repairs are ______ years old.
Clinical indications for replacing restoration include: Decay, Fracture, and Pain.
Do you need restoration?
If there are several composite restorations, it might be necessary to show signs of degradation and fracture. Replacement of restorations is typically not justified by the fact that amalgam contains metal or the patient desires white fillings.
Narrative of a dental claim for an onlay
The crown tale can be written using the same material as previously, but make sure to identify the cusp that is broken in the story. Include an intra-oral photo showing the missing or broken cusp, as well as a periapical photo (if available). For a restoration to be referred to as an onlay, the cusp must be entirely covered.
Narrative of a dental claim for veneers
the restoration’s age currently? or the date of initial placement
Medical justification for replacing the current?
A dental claim narrative that is effective for a veneer should contain language like this:
“Tooth number(s)____ have a 3-4 surface composite or an existing facial component.”
___ Fragmented (dentin exposed)
___ Rinsed off
Leaking or deteriorated
A veneer is required to restore function since the tooth structure that is still present cannot support another composite treatment.
dental claim for scaling and root planing
The condition the patient had at the time of the clinical evaluation should be included when creating a dental claim narrative that works for scaling and root planing. The phrase “Patient presents with periodontal disease with BOP, exudate, (if present) mobility, and generalised 4-6 mm periodontal probing depths” is one to take into consideration.
Use the code D0180 and adhere to the descriptor from the most recent CDT coding book if the dentist identifies signs of periodontal disease during the initial portion of the evaluation. Include a recent FMX and, if applicable, a periodontal charting with comparisons. The narrative may include any additional information from the dental hygienist’s or dentist’s clinical notes.
Dental claim example for a crown on an implant
Clinical justification for extraction:
Notes from the operation:
Because of _______________________________, implants are advised.
This effective dental claim narrative should be written up as follows:
Because of ____________________, tooth # implant implanted surgically to replace a lost tooth by . To preserve the integrity of the bone and facial structures and to restore chewing function in the arch, implant crown #___ and a bespoke abutment #___ were inserted.
Claims for implants and implant crowns should be submitted with a Panorex or FMX, periodontal charting, and narrative.
Send it out right away
Giving the claims examiner the right information the first time is essential to sending a clear claim for prompt payment. This will cut down on the time required to submit the claim again, or worse, to go through the drawn-out review procedure.
The supporting data needed will vary slightly from insurance company to insurance company and is always changing. We advise using the premier dental coding resource in the business to keep informed and make sure you are delivering the appropriate codes, attachments, narratives, etc.
Keep your narratives succinct while still providing the claim examiner with the details they need to pay the claim.
Dental Revu Help You
Sending accurate claims for prompt payment is more difficult than it seems. A thorough understanding of insurance standards is a prerequisite for successful dental billing because insurance carrier rules change at least once every year.
Think about hiring a qualified staff to handle your dental billing procedures. This keeps your cash flow steady while allowing your internal team to concentrate on what actually expands the practise.