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A narrative in the dental industry is a description of the patients problems and procedures. This is something you might see documented in clinical notes or the patients medical history.
Dentists use the pre-authorization process to determine a patients coverage. Sometimes a treatment plan has been pre-authorized or pre-approved by the carrier and the treatment is performed by the dentist with the expectation that the claim will be paid, but it is denied.
The narrative should generally cover the who, what, when, where, and why supporting the patients medical necessity. For example, the narrative for a ceramic crown may include the following details: Existing crown placement (if replacing) details with date and reason for replacement.
What is supporting documentation on a dental insurance claim? X-rays. Intraoral photos. Clinical notes (examples below) Charting. Narratives.
For example, services that may require pre-certification include outpatient and inpatient hospital services, observation services, invasive procedures, CT, MRI and PET scans, and colonoscopies. Patients are responsible for knowing the pre-certification requirements of their health plans.
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Prior authorizationsometimes called precertification or prior approvalis a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
With that in mind, here are 8 steps for faster dental insurance claims processing. Step 1: Verify eligibility ahead of time. Step 2: Get the coding right. Step 3: Double-check patient information. Step 4: Ditch the paper forms. Step 5: Include all relevant information. Step 6: Call for help if you need it.
Narrative: Initial placement of a crown on [Tooth #] due to a large old amalgam filling that is broken recurrent decay.

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