Week 4

Question 1

What is a pre-authorization?

Answer 1

A process to confirm that a high-cost procedure is covered by the patient’s insurance before it is performed.

Question 2

What documentation is typically required for a pre-authorization request?

Answer 2

CDT codes, X-rays, periodontal charts, intraoral images, and a clinical narrative.

Question 3

Why is a clinical narrative important in pre-authorizations?

Answer 3

It provides a detailed explanation of the treatment’s medical necessity, which helps justify the procedure to the insurer.

Question 4

What is the impact of missing documentation in a pre-authorization request?

Answer 4

It can result in delays, denials, or incomplete approvals from the insurance provider.

Question 5

How should a dental office follow up on a submitted pre-authorization?

Answer 5

Confirm receipt of the request, document the reference number, and track the insurer’s response timeline.