Dental Insurance Narrative Template
Dental Insurance Narrative Template – Introduction
The dental billing process, involving dental insurance claims may seem a little daunting. Dental billing is an activity that allows dental offices to collect remuneration for the services the dental office provided to their patients.
These remunerations are provided by insurance companies. To avail of these claims or remunerations, the dental office needs to submit a dental insurance narrative in their dental billing process.
What is a Dental Insurance Narrative template?
A dental insurance narrative is a form submitted by a dental office to an insurance company as part of their dental billing. It contains descriptions of the treatment or set of treatments offered to the patient and also the associated cost.
The purpose of submitting the dental insurance narrative is to claim reimbursements from insurance companies.
Step by Step preparation of a Dental Insurance Narrative
Step 1: Narrative format
The first step of sending dental claims involves preparing a narrative in the correct format. Roughly speaking the format of a dental narrative should include the following:
1. Presentation:
How did the patient present? What were your clinical findings? Based on the findings, what is the diagnosis?
2. Documentation:
Radiographic evidence to support diagnosis and/or Intra Oral photography.
3. Recommended treatment:
The recommended course of treatment should be clearly highlighted Dental practitioners can enter multiple procedures/set of treatments on a singe Dental Insurance Narrative
4. Final Treatment
The final treatment/procedures and the associated details should be clearly mentioned including expenses
Step 2: Dental coding
Dental coding is the process of using Current Dental Terminology or CDT to report patient procedures or treatments. It’s necessary that you use the correct CDT in your dental coding. You can find an updated list of CDT on the Americal Dental Association’s website. The codes are necessary in order to remain HIPAA compliant.
Step 3: Submitting the dental insurance narrative
Once you are sure that all the necessary information has been added to your narrative, and all correct codes have been used, you can go ahead and submit your dental insurance narrative.
How to make the process of Dental Insurance Claims easier?
Having your dental insurance claim denied is definitely a nightmare for both the patient and the Dental practice. However, there are some things that you can do to ensure that these claims don’t get rejected. Make sure you:
- Have a dedicated team for Dental Billing:
Dental billing itself has two branches, patient billing, and insurance claims. Billing the patient directly is patient billing and billing insurance companies is insurance claim billing.
Dental Insurance claim processes may be time-consuming and require in-depth knowledge of dental coding. It’s good to have a dedicated team handle it. If you do not have an in-house team for dental billing, you can also outsource it. - Ensure doctors add clinical notes for easy setup of the dental insurance narrative
In most cases, it’s not the dentist who is writing up the dental insurance narrative However, the narrative requires that details be given about the procedure performed. This information is known thoroughly to the dentist and not to the team handling the narrative. To get the team on the same page as the dentist adds clinical notes, If the clinical notes are not to the point, the billing staff may get confused.
To avoid this confusion, the dentist should make the clinical notes simple to understand and sans any mistakes. This will help the billing team easily prepare the narratives.
Clinical notes may contain things such as the patient’s personal information, medical history, missed appointments, unscheduled treatment, and any prescriptions or medications the patient is on.
One thing you can do to make the process of writing clinical notes easy for the dentist is to provide a clinical note template, The dentist may follow this template to ensure they do not miss anything.According to the ADA:“Another approach to making clinical notes in the dental record uses the acronym SOAP, which calls for the person making the entry to consider the Subjective, Objective, Assessment and Plan. This system can also minimize the risk of failing to include important details in the record.SOAP calls for:
Subjective: detailing the patient’s chief concern and related specifics such as how long the patient has been experiencing symptoms, when and where any pain might occur, etc.This would also include updating the medical/dental medical history information for existing patients and collecting complete information for new patients.
Objective: This part of the entry deals with the patient’s current health status such as blood pressure readings, exam findings, radiographic findings, and other diagnostic information, such as pocket depths, etc.
Assessment: This is your diagnosis of the patient’s condition, based on subjective and objective information. There may be several diagnoses to consider.
Plan: The unique treatment plan recommended for the patient. - Stay up to date with Dental Codes
Current dental codes or CDT are updated every year. You need to make sure that the code you are including in your dental narratives is the new and updated one. If you use outdated codes it may lead to confusion during your claim reimbursements or lead to incorrect payments. - Ensure unique narratives for each claim
Each patient has a different reason for their treatment and hence the narrative for each claim needs to be different. You may use a dental narrative template to make the process easier, but make sure to enter all the unique details in the template.
To note: Dental billing vs medical billing
There are some claims that you must not submit under dental billing. Some dental procedures come under medical care and should not be a part of dental insurance claims. Some dental medical care procedures include:
1) Treatment of damaged, teeth, gums, or jaw due to an accident or trauma.
2) Biopsy
Hence, these procedures would come under the medical insurance companies and not with a dental insurance company.
How to Best Use this Dental Insurance Narrative?
1- Customize it to the patients case
Using generic templates might not always lead to claim processing it’s important to customize the templates to align with the patients’ situation and procedures, So use this template as a baseline so that you don’t miss out on any relevant information
2- Keep it Brief and Informative
The idea is to ensure that all the relevant information an insurance officer would be looking for is easily available avoid very verbose narratives unless unavoidable
3- Include supporting documents
The necessary support documents might vary policy to policy but to ensure a smooth approval to dental insurance claims all the necessary supporting documents should be attached alongside the dental insurance narrative to ensure a smooth claim process
4- Retain a copy of your Dental Insurance Narrative
It’s always a good idea to retain a copy of your dental insurance narrative submission, this might be needed in the future in case there is some issue with your claim, it’s also a good idea to retain it as a part of your medical records and claim history.
FAQs related to Dental Insurance Narratives
- What is a dental insurance narrative?
A dental insurance narrative is a statement submitted by a dental office to claim reimbursements or payments from a dental insurance company. - What dental claims need attachments?
Attachments are typically not needed for a majority of basic dental services too. However, basic services such as periodontal procedures, root canals, extractions, and anterior composites may require pre and post-operative radiographs - Do you need a narrative for fillings?
Unless you are sure that a certain dental plan does not review fillings, always include a narrative for it. - What attachment needs to be sent with an insurance claim for a crown?
Crown requires Periapical X-rays as attachments. Crown could be Initial or Replacement. If replacement, give the initial placement date of the existing crown.
Eg -: Replacement crown. Original crown placed June 2021. Recurrent decay due to open margins causing pain and sensitivity. - What are the different methods for filing insurance claims dental?
Claims can be submitted either by paper or electronically