Q:

What documentation is required when submitting dental codes to insurance companies?

A:

Quick Answer

The type of procedure an individual is submitting dental codes for will dictate the documents to send in, but all submissions should have clinical notes and the process used to diagnose the issue as a minimum. Pathology reports and reports from specialists are also helpful.

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Full Answer

Many insurance companies do not need any additional documentation when submitting dental codes. Periodontal charts and clinical photographs are, however, suggested for certain procedures.

Some procedures do require supporting documentation, such as X-ray copies or dental charts. This helps the insurance company determine if the suggested treatment is covered under the patient's dental benefit plan. When an individual is submitting dental codes, he should always submit copies of X-rays, not the originals.

A written narrative should be included on any claim submission. This is a very important component of evaluating the claim. Claims that don't have a clear and concise outline of the procedure may not be approved or may be returned pending more information. Written narratives should be legible and state the current condition and the reason for the procedure. The easier it is for the insurance company to see why the procedure was required, the easier it is for the company to process that claim.

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