Narratives in Dental Claims
While the dental clinics’ staff must use CDT codes correctly on their claim forms, the staff may also have to include narratives to these forms so that the patients receive coverage for their treatments and services (Tekavec 2000). These narratives provide more information about the reasons for applying certain treatments to the patients’ conditions (Blair 2012). The clinics’ staff must have the writing skills necessary to write brief, yet informative narratives so that the insurance companies could approve their claims and pay for their patients’ treatments and services.
Narratives help persuade insurance companies to provide coverage on certain treatments. Albeit, according to Carol Tekavec, “a national lecturer with the ADA Seminar Series,” “(If a procedure is not covered under the terms of a contract, no payment will be approved, regardless of whether the patient requires the procedure or not and despite detailed and reasonable narratives.)” (2000). Tekavec also says, “Substitute completed and photocopied chart forms for written narratives whenever possible. A form documenting periodontal-probing depths, bleeding points, furcation involvement, recession, and mobility can take the place of a lengthy narrative and speed insurance processing” (2000). Though, when radiographs and images do not clearly show the problems associated with the patients’ teeth, dentists must explain the contents of the radiographs and images in their narratives to the insurance companies (Blair 2012). By doing so, they may approve the claim and cover the patients’ expenses (Blair 2012). Narratives may also gain coverage for patients by “[asking] for an alternate benefit,” “[if] a dental benefit plan has an ‘alternate benefit’ clause on the contract” (Banta 2011).
In order to write well-written narratives, they must be succinct and individualized for each patient and communicate the treatments’ necessity to the patient’s oral health (Blair 2012). If narratives extend beyond the space provided on the claim form, Patti DiGangi, author of the DentalCodeology book series, and Teresa Duncan, owner of Odyssey Management, a dental consulting firm, say, “A longer narrative on a separate page can lead to a claim being taken out of the auto-adjudication process and sent to an examiner. This can delay processing by two to three weeks” (2009). Staff members could prepare narrative templates, but dental insurance companies still require narratives unique to each patient (Banta 2011). To create such narratives, staff members should incorporate “the doctor’s clinical notes for information on each service” (DuCharme 2012). Furthermore, narratives must focus on “the functional, not the aesthetic, problems that need correction” since “restorations or replacements related to appearance typically are not covered” (Tekavec 2000). By following these tips, staff members could improve their writing skills for dental claims.
Successful brief narratives help inform insurance companies why the patient requires certain treatments, especially in situations where narratives must interpret images of the affected teeth (Blair 2012). Writing skills among staff members are necessary to help patients gain coverage.