A Treatment Plan With Multiple Treatment Options:
When submitting pre-determinations (or pre-treatment estimates) with multiple treatment options for your patient, submit each different treatment option on a separate claim form so that each pre-determination is processed independently. Add comments in the remarks section on the claim form noting treatment option #1, treatment option #2, etc. When you receive your pre-determinations back from us, you should see reference code 937 - optional treatment plans were submitted. Only one of the treatment plans will be allowed.
A Treatment Plan With Multiple Sequential Phases:
In order for a treatment plan with multiple phases to process chronologically, submit the different phases of the treatment plan on separate claim forms indicating the phase number in the remarks section (i.e. Phase 1 of 3, Phase 2 of 3, etc.). If you try to submit a multi-phase treatment all on one claim form, the procedures will automatically re-organize in numerical order by ADA codes instead of the intended treatment order.
Following these helpful tips should lead to a more efficient and accurate predetermination experience for your office.
Have additional questions? Contact your Professional Relations Representative.