Strong Dental Insurance Narratives and Reports
Strong dental insurance narratives mean faster claim processing. Fewer claim denials might also mean better dental office collections. And who doesn’t want that? Not all insurance codes require narratives though. So, it definitely pays to know which codes do. And then to know what the individual insurance carriers and policies require. Although, it’s really not difficult to do, there are a few things to learn. And it does take a little time.
Detailed insurance verification for each insurance carrier helps. Because when we gather specific and detailed insurance benefit information, we know how to send a claim. An insurance policy may state a procedure code is covered at a certain percentage and “by report”. Those words “by report” mean a narrative is necessary. Without a narrative, the claim is on hold for additional information. Or might even be denied. Sometimes, you may not even receive any notification of this at all. And the claim just sits unpaid.
What to Know!
What To Know
With dental insurance verification, gather the details. I highly recommend a phone call to each insurance carrier. Ask the insurance carrier representative for a list of the CDT codes that require narratives for them. And this may well vary from one company to another. But it is well worth the effort for those who are brand new to this process. In time, we just develop this mental store closet. But in the beginning, we need direction.
Here are some examples of CDT codes that may require a narrative or report from Blue Cross of Idaho. Additionally, there are other circumstances to consider. For example, a tooth may require more than one restoration due to decay in different spots on that tooth. Additionally, those areas may not touch. So, the dental practice submits a claim for two fillings on one tooth. And does well to include a narrative to support the two separate restorations on one tooth.
Strong Dental Insurance Narratives by Example
Let’s consider a tooth with two separate restorations. An example of this narrative is “composite placed in distal occlusal pit. A separate composite restoration placed in mesial occlusal pit. Restorations do not touch or connect. Please reimburse as two separate restorations”.
Here is an example for an occlusal guard narrative. “To treat bruxism due to grinding at night. Patient describes jaw pain upon waking”.
Crown build-up is sometimes a separate benefit under a dental plan. And other dental insurance companies consider the buildup as part of the crown. It pays to know this information when asking for your patient copay. However, I prefer to bill each and every crown buildup and crown exactly the same. And that includes a narrative. For the crown build-up I say something like “more than half of this tooth structure is missing. buildup required for crown retention”. Be sure to include initial placement date if this is a replacement crown. Or the estimated initial placement date if no exact date is available.
Detailed Chart Notes Are Great Tool!
Attach the patient chart notes to their dental claim. The chart notes are legal medical documents and hold all the information this claim needs. In fact, the chart note can be the narrative. Of course, the chart note must say what we need it to say. The patient chart notes also give detailed history and documentation of prior treatment. Print a perio chart when appropriate (such as with surgical and periodontal procedures). And all pertinent x-rays and photos to help support your patient’s claim.
Strong Dental Insurance Narratives Describe Function
How does this patient’s tooth work and hold up as they present for treatment? Describe the patient’s problem and inability to function with the tooth or teeth. Avoid words that describe how the tooth or teeth appear. Remember, the dental insurance representative looks for a reason to deny a claim. So, we must be sure we provide only reasons to pay the claim.
Decay is a word you will use repeatedly. Decayed surfaces, decayed margins, open margins, and fractured teeth are words that bring insurance benefits. However, erosion, attrition, abrasion, and abfraction are more likely to cause a claim denial. Not that I recommend false reporting by any means. These are just some things to know!
Keep Each Narrative Unique
It’s okay to use a narrative template. But also make each narrative unique. Keep the narrative short and sweet but detailed and informative. Use the words that provide the claim’s processor with the information they need. This will get the dental practice paid sooner. And again, I highly recommend attaching the chart note. Just be sure to write in section #35 on your claim that narrative is attached.
Dental claims, billing and follow-up are not difficult tasks. They do require attention to detail and consistency. Put the work in before you send the claim. This will save everyone on the team the headaches that come when a claim goes unpaid. A delay of payment is a problem for the entire business. It also creates more work for the administrative team. And can cause unnecessary strain in your patient relationship as well.
What dental insurance narratives do you need help with? I’m working on a FREE download for you. Your input is helpful. Provide your email address and I’ll send you the download as soon as it’s ready! Thank you.