Creating a Primary Pre-Authorization

Pre-authorization estimates appear similar to insurance claims, but you send them before performing the treatment for a patient. When you send a pre-authorization, the insurance company sends back a coverage estimate that you can use to estimate the patient’s out-of-pocket expenses for the procedure(s). In some cases, insurance carriers require a pre-authorization before you can perform specific procedures.

Watch this video to learn how to create a primary pre-authorization estimate. (Duration 0:36)

Additional Tips

• You must treatment-plan the procedures you want to include on the pre-authorization claim.
• When you work with treatment plans, you can change the Ledger’s view to display the patient’s treatment plan. Here you can locate the pre-authorization estimate for the patient.
• If the patient has an extensive treatment plan, you should be selective in what you send a pre-authorization claim for and when you send it. Try to submit these claims as close as possible to the date you’ll begin treatment.
• You can select multiple treatment-planned procedures by holding down the CTRL or Shift keys as you click on the procedures.
• If insurance companies require a pre-authorization for specific procedures, you can flag those procedures in the coverage table. Then, when you treatment-plan one of those procedures, you’ll see  “1**” in the Ins column of the Ledger’s Treatment Plan view.
• To learn more about creating a primary pre-authorization, read Creating Primary Dental Pre-Authorization Estimates in Dentrix Help.
• To learn more about adding attachments to a claim pre-authorization, review the Sending Claim Attachments Overview topics in Dentrix Help.

Check Your Knowledge

If you have access to Dentrix, check your knowledge with this exercise.

1. Switch to the Dentrix demo database.
   (Skip this step if you are using the Dentrix Learning Edition software.)
2. To complete this exercise, you may need to post a treatment-planned procedure in the Ledger for Dean Little.
3. Create a primary pre-authorization estimate for Dean Little.