Question: Do you have any great narratives for submitting Delta Dental SRP benefit claims?

We are looking for a good narrative for SRP. We have found that many of our claims to Delta Dental, although they tell us when we call for benefits, that they allow for all 4 quads in the same visit with documentation, then, deny it stating that they don’t find it necessary by consultant review. We only submit for SRP with probing depths over 4mm and we send the periodontal chart, the chart notes and x-rays. We often even submit with intraoral photos showing calculus build up and inflammation but they still seem to deny many of our claims for SRP to Delta Dental. We aren’t seeing that for all other insurance companies but want to make sure we are safeguarding ourselves. Please let us know if you have a great narrative that you can share with us.

ANSWER:  We certainly understand the frustrations with insurance companies and their propensity to deny claims. We must always remember the insurance belongs to the patient so we need to start by always letting the patient know we are doing the best for their dental health by providing the recommended treatment.[mepr-show if=”loggedout”]Members only resources[/mepr-show] [mepr-active memberships=”629,630,37388,37393,37672,37676,37670,37668,37674,44674,232156″ ifallowed=”show” unauth=”message” unauth_message=”Answer hidden, please login or purchase a membership to view.”] We will be happy to file their insurance claim for them but the insurance companies can and are in the business to deny claims whenever they can so if they have an issue with what the insurance company denies, etc. they should take it to their HR department for review. If the corporation/company providing the insurance to their employees complains enough to the insurance companies or threatens to leave that is the only time the insurance companies seem to sit up and take notice.

The 3 D’s with insurance companies are Delay, Decline & Deny. The most common mistake made when filing an insurance claim is the absence of information and attachments. Providing the wrong information can cause headaches, but also not providing the right amount of information can cause the same delay or denial. Also, providing the same, unvaried, or routine narrative for claims that are similar can also raise red flags to the insurance examiner so vary them each time they are sent especially when sending to the insurance carrier you are having issues with.

The narrative should always contain the periodontal condition that the patient presented with at their exam as well as the amount of time it has been since they were last seen in a dental office. Most carriers want also require the American Academy of Periodontology Case Type explained on the claim form as well.

Example: “Patient stated they have not been seen in a dental office or had any type of periodontal care since (Date/or approximate amount of time.) Patient presented with Case Type III-Moderate Periodontitis including generalized 4-6 mm periodontal probing depths, Bleeding on Probing, Mobility (state specific teeth if not generalized) exudate, (if present).”

Also mention the amount of deposits present and refer to intraoral photos for evidence of this, furcation involvement, missing teeth and recession. Always include a current FMX w/BWX or preferably VBX and periodontal charting showing comparisons, if available. As well, any other detail from the hygienist’s or doctor’s clinical notes and intraoral photos, if available.

Also, be sure you are up to date with the new code that has been introduced and available for use as of January 2017. Here is a link to the ADA site with more information.[/mepr-active]