DENTAL CONSULTANTS CORNER

Claim appeals or reconsiderations
When resubmitting a claim to appeal a benefit decision by the dental consultant, please clearly mark on the claim that it is for reconsideration. This will allow us to properly identify the claim as a reconsideration and not include it with other claims. Claims for reconsideration require submission of pre-treatment x-rays, photos and narratives. Be sure to submit more information than was submitted the first time, otherwise the consultant's re-evaluation may result in the same decision. If you are unsure of when to submit x-rays, photos, etc., please refer to the "Required Attachment Documentation" list included in this issue.

Corrected billings
If you are resubmitting a claim due to a procedure-code error, please include chart notes to support the change in procedure code. Depending on the procedure code being resubmitted, we may also need pre-treatment x-rays. Be sure to submit the procedure code that best describes the actual procedure performed (i.e., buildup vs. restoration). Never alter codes to obtain benefits for the patient.

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