General Rules for submission of claims (1)

X Rays should be labeled when saved as the following,

Left BW, Right BW, Upper PA, Lower PA, Pano unless it is issued for a specific tooth

If a second Xray is needed for the same area it is to be labeled with the

number 2 such as Left BW 2

Lastly if the X Ray was taken prior to treatment it should belabeled a

“pre” and after treatment as “post

X Rays are needed for Every procedure except

examinations, x rays, or fillings.

A: Bridge

BWs of both abutments clearly showing bone levels of eachtooth

B:Crown -

BW of tooth labeled with the tooth #, preferably with the toothcircled

C: Extraction

Pano

G: Partial denture / Denture

Pano

E: Periodontal Maintenance

FMX one image

F: Root canal

Preoperative and Postoperative PA of the treated toothlabeled with the tooth # and pre/post as explained before

G: SRP - segmented FMX

meaning individual saved Xrays with circlesaround calculus when present. I

Individual means

blown up BW’s and PA’s. Do notsend the FMX as one Image!!!

Alveoloplasty

Surgical preparation of the alveolar ridges for the reception of dentures, shaping and smoothing ofsocket margins after extraction of teeth

Arestin:

restin is the antimicrobial agent used on the bleeding points nothealed yet. Pocket depth above 5 and per ADA guidelines Arestin iswarranted to the patien

Build up

Patient has recurrent decay around old filling that needs to be removed. Once the old filling is removed abuild up with resin based composite will be placed in order to replace missing tooth structure that willbe needed in order to support the retention of a new crown

bridge claim

Ws of both abutments clearly showing bone levels of eachtooth, Narrative for bridge, Initial or replacement, Extraction date of missingtooth. Preauthorization # if applicable

B:Crown claim

BW of tooth labeled with the tooth #, preferably with the toothcircled, Narrative for crown, Initial or replacement. Preauthorization ifapplicable

C: Extractions -

ano that clearly shows problem tooth or teeth, narrativefor extraction, preauthorization if applicable

Partial denture / Denture

Pano, Narrative for partial / denture .Missing tooth numbers for partial denture, extraction dates of missing teeth,Initial or replacement, seat date for prosthesis. Preauthorization numbe

E: Periodontal Maintenance

FMX one image, periodontal charting,date of SRP

F: Root canal

Preoperative and Postoperative PA of the treatedtooth labeled with the tooth # and pre/post as explained before. Narrativefor RCT, preauthorization number if applicable.

G: SRP

segmented FMX, meaning individual saved Xrays withcircles around calculus when present.

Individual means

blown up BW’s and PA’s. Do not send the FMX as one Image!!!

PPO claim submissions: F

Follow the rules as seen above for all claim submissions.SRP quadrants to be sent as 2 quads per day, Make a notation for submission forclaims on the following day for subsequent quadrants

Argus

Argus: Preauthorizations for Dentures, Partials with Extractions, SRP can be sent all 4quadrants, no preauthorizations for root canals,crowns or extractions (use specific ICD10 codes

Dentaquest (Kids):

Preauthorization for root canals and crowns, SRPs / dentures arenot for kids. Dr. S send claims

Envolve:

Preauthorization for all procedures including SRP, extractions, root canals,dentures, partials, crowns, bridge work, implants, ARESTIN, etc

Liberty Devoted: Pr

authorization for all procedures, crowns, bridges, partials,dentures, root canals. SRP send two quadrants at a time. No pre-authorization for SRPor extractions

Liberty AETNA:

authorization for all procedures, SRP, crowns, bridges, partials,dentures, root canals. SRP send two quadrants at a time

Liberty Medicaid:

Preauthorization for any procedures under kids plan, crowns,bridges, partials, dentures, SRP send two quadrants at a time, or SRP, RTC, Core buildup or extractions. Send crown on crown seat date along with a PA of crown seated

MCNA

Preauthorizations for crowns, root canals, partials, dentures, extractions. SRPnot required for preauth, send all SRP quads same time Dr S send claims

UHC Medicare:

Preauthorizations for crowns, bridges, implants, AND ARESTIN. Nopreauthorizations for endo, dentures, partials, extractions or SRP. SRP send all 4quadrants at the same time

Envolve:

Bone graft code accepted is D4263

D6010 Implant placement

Our fee $1000

D586

Precision attachmen

D6191

Semi-precision attachment initial placement $500

D6192

Semi-precision attachment Replacemen

D6055: Connecting Ba

implant supported or abutment supported