Two common causes for immediate denture claims to be denied are:
- The denture claim submission has the impression date rather than the seat date for the date of service.
- The extractions were provided by an oral surgeon/different provider, and the claim for the dentures was received by DDKS prior to the claim for extractions.
How to avoid claim denials:
Indicate the date the denture is seated in the patient's mouth as the procedure date on the claim form when submitting for payment of immediate full or partial dentures.
When a claim for immediate dentures is received prior to the claim for extractions, the denture claim will be denied using the following reference/reason code 511: Seat date of appliance must be on or after the extraction(s) date for benefits to be provided.
National Delta Dental policy:
Multistage procedures are reported and benefitted upon completion. The completion date is the date of insertion for removable prosthetics. Helpful guidelines for submitting claims can be found in your Dentist Handbook in the What You Need to Know section. You can access your Dentist Handbook by logging into your Dentist Account and selecting Documents and Dentist Handbook under the Quick Links section.
Please note, payment for immediate full or partial dentures cannot be provided unless extractions have been submitted or recorded in the patient's history dated on or before the denture seat date.