Step 2 of 8 in the billing cycle
Dental pre-authorizations and pre-treatment estimates
We prepare and submit pre-authorizations and pre-treatment estimates for the treatment that needs them, with the radiographs, charting and narratives each payer expects. Then we track every request until there is an answer, so treatment is not left waiting on a form nobody is watching.
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Treatment planned: scaling and root planing, four quadrants (D4341).
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This plan asks for a current periodontal chart with the request.
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Attached the perio chart and full-mouth x-rays.
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Narrative drafted from the clinical notes.
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Dentist reviewed the narrative. Request submitted.
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Approved. Treatment coordinator notified.
Why pre-authorizations stall treatment
Crowns, bridges, implants, periodontal treatment and orthodontics often need a pre-authorization or a pre-treatment estimate. Each payer wants something slightly different: a current periodontal chart, a pre-operative x-ray, a narrative that explains why the treatment is needed now.
When a request goes out without what the payer wanted, it comes back asking for more information. Days turn into weeks. The patient loses momentum, and the treatment plan your doctor presented sits in limbo.
How we handle it
Experienced billers do the work and make the decisions. AI does the reading, checking and watching that keeps the work complete.
What our billers do
- Identify planned treatment that needs a pre-authorization or estimate under the patient’s plan.
- Gather radiographs, periodontal charting, photos and clinical notes from your system.
- Finalize the narrative, have the dentist review anything clinical, and submit the request.
- Follow up with the payer until there is a determination.
- Share the result with your treatment coordinator so the patient conversation can happen.
Where AI helps
- Checks planned treatment against the patient’s plan to spot pre-authorization requirements early.
- Lists the documentation the payer typically asks for with that procedure, so nothing is missing on the first send.
- Drafts a narrative from your clinical notes for the biller and the dentist to review and edit.
- Tracks open requests and flags the ones that have gone quiet.
What your office gets
- Requests go out complete
- The x-rays, charting and narrative the payer expects are attached the first time.
- Treatment conversations with real numbers
- Your coordinator can talk with the patient using the payer’s answer, not a guess.
- Nothing gets lost
- Every open request has an owner and a follow-up date until it is decided.
What we need from your office
- Treatment plans entered in your practice management system.
- Dentist review of clinical narratives before they are sent.
Questions about pre-authorizations
What is the difference between a pre-authorization and a pre-treatment estimate?
Some plans require a pre-authorization before certain treatment will be covered. A pre-treatment estimate, sometimes called a pre-determination, is the payer’s estimate of what it will pay. Neither guarantees payment. The final amount depends on eligibility and benefits when the claim is processed.
Does our dentist have to write the narratives?
No. We draft them from the clinical notes. Because a narrative speaks for the treating dentist, anything clinical is reviewed by the dentist before it is sent.
What happens when a request is denied?
We read the reason, gather what the payer says is missing and resubmit, or bring the answer to your team so you can talk with the patient about options.
See where your billing is leaking.
A free billing review looks at how claims move through your office today and where revenue slips. You get a plain answer on what we would change, with no obligation.