Dental billing: Ensuring patient understanding and timely reimbursement

Dental billing can be tricky, especially given the components involved. Understanding all the factors, which can include integral services, preauthorizations, and predeterminations, can help ensure that you will be reimbursed faster (and in the correct amount) and can more effectively communicate with your patients about the services covered by their plans.

Integral services

Dental procedures categorized as integral services are considered essential to a primary procedure. They are not billed separately. For example, gingival irrigation (D4921) is commonly used following periodontal procedures like scaling and root planing (D4341/D4342). Since gingival irrigation is integral to the periodontal procedure, it should not be billed separately. Understanding which services are integral helps ensure accurate billing and compliance with insurance guidelines.

Preauthorization vs. predetermination

A predetermination is an estimate of coverage, while a preauthorization is a required approval. Although we do not require our participating providers to submit preauthorizations, it’s important to understand the difference between preauthorizations and predeterminations.

• Preauthorization: This is a required approval from the insurance company before a patient receives certain treatments or expensive medications. It confirms that the recommended treatment is covered under the patient’s insurance plan.

• Predetermination: This process involves submitting details of a proposed procedure to the insurer before treatment. It’s an estimate that helps determine coverage, the approved payment amount, and the patient’s financial responsibility. While it does not guarantee final approval, it estimates what the insurance covers and what the patient owes. Final approval is always determined based on medical necessity.

Understanding the complexities of dental billing helps your patients understand their financial responsibilities. Thank you for continuing to provide our members with essential, quality dental care and for ensuring they have the information they need to take full advantage of the benefits covered by their BlueDental plans.