Please consider my appeal and pay for my root scaling procedure as it is included in my plan and the procedure was pre-authorized and medically necessary. Tulsa, OK 74133, Main: (800) 670 2809 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 … D4341 periodontal scaling and root planing – four or more teeth per quadrant The patient did some research and wrote this dental insurance appeal letter sample. The denial states that the procedure was not medically necessary. 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. Example: Yes, I would like to receive emails from Outsource Strategies International. The records clearly show that gingivitis is present in my gums and there has been some soft tissue loss around my teeth. Insurance companies look to make sure your patient meets a certain criteria when the company considers a claim for scaling and root planing. APPEALING A DENIED CLAIM OR SERVICE You also want to make sure that you are well within your rights to request a second look at the denied charges. HIPAA recommends using the version of the CDT Code in effect on the date of service, no matter when the claim is submitted. In the event your dental insurance company refuses to pay for a procedure that you believe to be covered under your plan… Notice that the definition is clear in stating that this procedure is to be instituted for the life of the dentition. Keep the periodontal chart for your record; however, submittal is not required. Other Tips to Prevent and Resolve Such Claim Errors. 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. And certain procedures, such as periodontal scaling and root planing (SRP), tend to have a 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. • Maintain the originals of all radiographs, photos, and notes you send to the Medi-Cal Dental Program for your own records. Most insurance companies provide their customers with a booklet that details the coverage in their particular plan. 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… D4341– periodontal scaling and root planing – four or more teeth per quadrant. Periodontal Scaling and Root Planing Policy United Concordia’s policy for claims submission of periodontal scaling and root planing (PSRP) (D4341, D4342) requires submission of diagnostic materials from all general dentists and non‐ periodontal specialists, regardless of the patient’s age. This addition to DIQ's downloadable dental forms will help your practice collect what's owed to you for scaling and root planing. Insurance carriers failing to release specific payment guidelines or processing policies for specific procedure codes is a major factor that creates confusion in actual benefits. March 19, 2018. Log on to the message boards of Dentaltown.com today to participate in this discussion and thousands more. The purpose of this procedure is … If there is no error in the claim, prepare an appeal. 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. 1. MetLife Denied Root Planing Claims are denied for many reasons. Coverage on periodontal scaling and root planing (SRP). Outsource Strategies International. However, some state laws and third party carrier processing policies and contract provisions specify the completion date as the date of service. This procedure was performed on the 15th of July this year. Dental Insurance Appeal Letter Sample Note: Make sure to state why you believe they made the wrong decisions. ADA’s Recommendations on How to Appeal a Dental Claim, A proper appeal involves sending the carrier a written request to reconsider the claim, Four Major Dental Claim Rejections and How to Respond. Front Desk Help Center Informative tips to simplify claim procedures and processes . Cosmetic appeal – Scaling and root planing helps to remove tartar and plaque from the teeth and below the gum line. Below the gum line is indicated for patients with periodontal disease is (... Surface is rough it is indicated for patients scaling and root planing appeal letter periodontal disease is by dental! Investigational, or cosmetic the definition is clear in stating that this.!, experimental and investigational, or cosmetic limited benefits for this procedure was not medically necessary, experimental and,! 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