Tips to Submit Multi-Option & Multi-Phase Pre-Treatment Estimates

July 02, 2019

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.