You’ll receive a local anaesthetic to numb the area. Keep the periodontal chart for your record; however, submittal is not required. E-mail: info@managedoutsource.com, Home | About us | Contact us | Blog | News | Sitemap | Reviews | Disclaimer Based on the patient's clinical presentation, I placed PerioChip® in each of the pockets listed below: Tooth # Site Treated (MB B DB ML L DL) Probed Pocket Depth Total Treated Areas by Tooth If there is a coding error, prepare and submit a corrected claim. However, some state laws and third party carrier processing policies and contract provisions specify the completion date as the date of service. Secondly, ask the dentist’s office staff to give you copies of your records, including any x-rays and reports that support your claim that the procedure should have been covered. All Rights Reserved. To write this type of letter, you need to be mindful that you are dealing with a business, and it should be a formal style letter. I have also included a letter from my dentist explaining why, in her expert opinion, the root scaling procedure was medically necessary and what the consequences would be of not performing the procedure. Here’s what to expect if your dentist or dental hygienist recommends these techniques: You won’t feel it. Before submitting a claim for scaling and root planing, check the company's guidelines on their website or in the provider's office reference guide. The patient did some research and wrote this dental insurance appeal letter sample. This procedure performed following periodontal therapy and at varying intervals is frequently denied because many carriers have limited benefits for this procedure. Before you write this letter, make sure you read your policy and know your rights. In the event your dental insurance company refuses to pay for a procedure that you believe to be covered under your plan, you can write a dental insurance appeal letter. Other Tips to Prevent and Resolve Such Claim Errors. Narrative should contain the condition that the patient presented at the time of clinical examination. Send your appeal letter to the specified department of the carrier and it must be in the form the carrier requires, Include the word “appeal” in the title and the text of the document and in any cover letter that accompanies the appeal document, D4341 periodontal scaling and root planing – four or more teeth per quadrant, D4342 periodontal scaling and root planing – one to three teeth per quadrant, D2950 core buildup, including any pins when required. Following is a sample of an appeal letter to medical insurance company in the case of a denial based on medical necessity. Periodontal scaling and root planing involves the removal of calculus, bacterial plaque, bacterial toxins, diseased cementum (the outer covering of the root surface), and diseased tissue from the inner lining of the crevice surrounding the teeth. Patient eligibility verification is a key factor in preventing claim denials. Sample Medical Insurance Appeal Letters Sample Letter 1. One way to diagnose periodontal disease is by taking dental x-rays. The deadline for appealing a planning decision is 12 weeks from the date of the decision notice. APPEALING A DENIED CLAIM OR SERVICE I hope this letter finds you well. In the event your dental insurance company refuses to pay for a procedure that you believe to be covered under your plan… Scaling and root planing is a procedure that treats the infected area by meticulously cleaning the tarter and bacteria from the teeth and their roots. My x-rays and other records from my dentist are attached. Detecting Periodontal Disease. While some payers have limited this procedure to be paid as a benefit only within 2 to 12 months of SRP, other payers have qualified periodontal maintenance by denying benefits for this procedure unless two or more quadrants have received prior therapy. It is important to read your booklet carefully so that you understand what kinds of procedures are covered and, more importantly, which procedures are not covered. This Clinical Policy Bulletin expresses Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Dental insurance companies are a thorn in the side of providers, and they are adept at creating frustrations by delaying and denying justifiable claims. 2. Frequencies for denial are more with certain procedures such as periodontal scaling and root planing (SRP) than other procedures or requests. Insurance companies look to make sure your patient meets a certain criteria when the company considers a claim for scaling and root planing. Page | 2 Follow specific instructions provided by the particular carrier including the submission of the appeal in writing within the time allowed by the carrier. Use the correct, current code set to identify the diagnosis, services rendered, and procedures performed. Fresher breath – A very common signs of periodontal disease is halitosis (bad breath). For SRP claims, try including documentation of radiographic evidence of bone loss, periodontal charting and a narrative description of procedures. D4346 – scaling in the presence of generalized moderate or severe gingival inflammation – full … Periodontal scaling and root planing, per quadrant involves instrumentation of the crown and In this case, a patient needed a root scaling due to gingivitis and loss of some soft tissue around the teeth. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of le… initiated included scaling and root planing and oral hygiene instruction. Provide a clear narrative Outsource Strategies International. I am writing to appeal the denial of my claim number 789 for my root scaling procedure that was performed on September 3, 2013. Copyright © 2020. Bacteria release sulfur waste products. Outsourcing dental insurance verification tasks helps hospital staff to focus on their core task and practices can also save time and money. Such companies will provide the services of skilled AAPC-certified coders and expert billing specialists who can ensure that your practice has only fewer accounts receivable and unresolved dental claims. In the Feb. 5, ADA News article " ADA Resources Can Help Dentists With Scaling, Root Planing Claims Process ," author David Burger notes that periodontal scaling and root planing have the … Furthermore, superficial stains present on the teeth will be removed in the process of the scaling and root planning. Front Desk Help Center Informative tips to simplify claim procedures and processes . 2) Radiographic evidence of noticeable loss of bone support. Also include your policy, group and claim numbers in your appeal letter. Dental Insurance Appeal Letter Sample Note: Make sure to state why you believe they made the wrong decisions. The purpose of this procedure is … D4341 periodontal scaling and root planing – four or more teeth per quadrant D4342 periodontal scaling and root planing – one to three teeth per quadrant Dental claims can be denied, delayed or alternate benefited for a myriad of reasons. What does this mean? The whole purpose of the letter is to ask for reconsideration. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in … Scaling and root planing are common nonsurgical techniques that may prevent the need for more serious procedures. You’ll also need to submit any other documents that directly support your appeal, for example your grounds for appeal. , explain yourself well and enclose any documentation necessary check whether the procedure pre-authorized denied planing! And calculus to attach on it total fee for the life of the letter is to be instituted the... The company considers a claim for root planing claims are denied for its lack benefits! 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