Submitting complete, accurate claim information helps reduce avoidable denials and requests for corrected claims. Use the tips below as a quick reference when submitting dental claims to Select Health, especially when additional documentation is required.
What supporting documentation is required?
When a claim includes codes that may be covered only with additional documentation, mail, fax, or submit the claim online with the applicable x-ray, perio chart, and/or chart notes.
Including key documentation up front can help support timely claim review:
- X-rays: Submit x-rays that are clear and of diagnostic quality. X-rays must include the patient’s name and the date taken. Faxed x-rays may become distorted and may not be considered diagnostic quality.
- Perio charts: Include the member’s name and exam date. Select Health follows the ADA definition of a current perio chart, which is less than six months old. Perio charts dated after the date of service do not support the procedure.
- Chart notes: Notes must include a legible signature from the dentist who performed the services. Electronic documents must be authenticated and signed appropriately.
Records and chart notes copied and pasted into a Word document or submitted as a screenshot of the records or chart notes are not considered acceptable formats.
If reporting a core build-up on a tooth that received a same-day crown, submit chart notes that support that the build-up was placed as a separate restoration from the crown. The notes should explain how the build-up was placed and what materials were used.
What are the requirements for Vyne submissions?
All records that are submitted online through Vyne must adhere to the Select Health standards outlined above. If chart notes are being submitted, they must be in legal chart note format and include all the above requirements. Information that is added to the provider narrative section is not considered complete legal chart notes. X-rays must include the patient’s name, and perio charts must include both the patient’s name and an exam date.
How do I use the American Dental Association claim form?
When submitting a claim, the provider reported in box #53 of the American Dental Association (ADA) claim form must be the treating dentist and treating location for the services performed on the date reported.
Some CDT codes require a tooth number, tooth range, quadrant, or arch. If this information is missing from the claim form, the code may be denied, and you will need to submit a corrected claim. A written note or chart note is not acceptable in these cases.
Refer to the ADA Coding Companion Guide to confirm CDT code requirements before submitting a claim.
What dates are needed for crowns, pontics, and implants?
Specific dates must be recorded for the following procedures:
- Replacement crowns: Include the previous placement date of the original crown on the claim image.
- Pontic crowns or implants: Include the extraction date for the applicable tooth number.
What are the new barrier membrane codes?
Prior to January 1, 2023, the only existing barrier membrane codes were D4266 and D4267. The ADA has since created new barrier membrane codes for different types of barriers and conditions. When reporting barrier membrane codes, legal chart notes must include the name of the product placed.
Use the following codes when placing a barrier membrane: