Free Narratives and Attachment Guide for Dental Insurance Claims (2024)

Part 1: Narratives and Attachments

To say this training was a labor of love is NO JOKE! I am so excited to share with you the best tips for getting your claims paid and a couple of tips and tricks we have found helpful over the years. (PLUS insurance company-specific requirements).

This hot topic is big and we never want content that takes more than 10 minutes to learn so, here is part ONE. Come back for part two soon.

First, dental billing is waaaayyyyy different than medical billing. The coding and sending of claims is a unique process. It requires specific attachments, narratives, and information not readily needed on medical claims. Dental coding is based on Current Dental Terminology codes which are governed by the American Dental Association. Each year, the ADA provides code updates, revisions, deletions, and more. Staying up to date with these will be the first step to ensuring your claims are always submitted properly.

Most dentists do not readily outsource their dental billing and coding procedures and we highly recommend this. Oftentimes, we see tiny breaks in processes of narratives, attachments, and claim submissions which can be avoided with just a few tweaks. Dental billing is a position that should be maintained by a specific position in the office rather than a blanket job for everyone to have a hand in. This training will provide your dental office with those very tweaks needed to improve claims and close the revenue cycle much faster.

Narratives + Attachments

Let's break this down by category and what you need to submit with claims.

You might be like me and find that our doctors do not always put a clinical note in that helps us get a claim paid. So, we are going to help you with some templates you can use. No, we don't guarantee anything however if clinical notes are sparse, these templates can work wonders. Always check with your owner before implementing anything you find here.

Alrighty... let's go...

Osseous Surgery:

Attachments: Intraoral photos if possible

Narrative: Necessary to detoxify the root surface and to prevent further bone loss.

4263 +/or 4265 Bone Graft Replacement:

Attachments: Intraoral photos if possible

Narrative:

Necessary to potentiate new attachment and to promote bone regeneration.

4341/4342 SRP- Scaling and Root Planing:

Attachments: FMS (Full Mouth Series) and Periodontal Charting/Perio Chart)

FMX and PERIO CHART attached.

Narrative: Scaling and Root Planing necessary to remove subgingival microbiota both alive microorganisms and dead to prevent further bone loss.

Optional Narrative: The patient has BOB, inflammation, unattached gingiva, with puffing interdental papilla, 5mm pockets in each quad or higher, sub and supra calc with tartar, poor OH. Needed due to gingival migration and bone loss. The patient presents heavy deposits and severe gingivitis. To treat patients needed to be anesthetized for a through S/RP. Radiographs show loss of crestal bone and to prevent further bone loss and attachment S/RP was diagnosed to which the patient agreed to treat.

4355 Full Mouth Debridement:

Attachments: FMS + Periodontal Charting)

Narrative: Full Mouth Debridement is necessary to remove heavy build-up of plaque and calculus in order to perform a comprehensive examination in the future.

D4910 Periodontal Maintenance Treatment:

Attachments: Periodontal Charting/Perio Chart

Narrative: For CIGNA AND METLIFE (mandatory documentation): Include the SPR Hx(history) as narrative.

Ex: SPR done on (mm/dd/yyyy) at UR and LR.

Gingivectomy:

Attachments: Intraoral photos if possible

Narrative: Gingivectomy is necessary due to excision of the soft tissue wall surrounding a gum pocket in [Teeth #'s].

Free Narratives and Attachment Guide for Dental Insurance Claims (3)

Inlay/Onlay (Code varies by material type):

Attachments: pre-op x-ray and post op x-ray

Narrative: Multiple fractures cusps, decay/recurrent decay, existing failing restoration minimally invasive procedure performed. Favorable prognosis and the patient has no further symptoms.

2740 Crown (Code varies by material type):

Attachments: pre-op and post-op x-ray

Narrative: Indicate if it is an initial placement or a replacement.

Initial placement or existing crown replacement [date] . (SEAT DATE NOT PREP DATE).

For replacement: Improper/poorly fitting EXISTING crown open margins, recurrent decay, the tooth requires full coverage support and favorable prognosis ….pt has no symptoms. Prior placement on [date].

2931/ 2930 -Stainless Steel Crown/SSC:

Attachments: pre-op and post-op x-ray

Narrative: Stainless steel crown on #_____ to restore the tooth from decay for longer-term effectiveness in preventing recurrent caries.

More on Crowns...

Crown due to decay:

Attachments: pre-op and post-op x-ray

Narrative: [Tooth #] has been destroyed by caries/fracture and requires crown restoration.

Crown with core build-up due to composite failed:

Attachments: pre-op and post-op x-ray

Narrative: Initial placement of a crown on [Tooth #] due to large old composite filling that is broken & recurrent decay. <50% natural tooth left. A build-up & crown is necessary to properly restore the tooth.

Crown with core build-up due to amalgam failed:

Attachments: pre-op and post-op x-ray

Narrative: Initial placement of a crown on [Tooth #] due to a large old amalgam filling that is broken & recurrent decay. <50% natural tooth left. A build-up & crown is necessary to properly restore the tooth.

Crown for Implant:

Attachments: pre-op and post-op x-ray

Narrative: [Tooth #] was extracted on mm/dd/yyyy. A surgical implant was placed to replace the missing tooth on mm/dd/yyyy. Implant crown and custom abutment were placed to restore chewing function in the arch and to retain the integrity of the bone and facial structures.

Crown Lengthening:

Attachments: PA x-ray and BW x-ray

Narrative: Crown lengthening needed on [Tooth #] due to improper biological width. Without the procedure, the crown margin would have been placed too close to the bone.

Redo Crown/Core Build-up:

Attachments: pre-op and post-op x-ray

Narrative: [Tooth #] date of original placement was mm/dd/yyyy. Needs build-up and new crown restoration due to excessive decay and/or margin opening.

Veneer

Attachments: pre-op and post-op x-ray

Narrative: Large missing or damaged Enamel, or incisal, facial surfaces require coverage due to lack of support/structure, the only alternative would be a crown, DDS diagnosed least invasive procedure. Favorable prognosis and the patient has no further symptoms.

Bridge

Attachments: pre-op and post-op x-ray

Narrative: Bridge prepped site [Tooth #] and [Tooth #] was extracted on mm/dd/yyyy or (cognitively missing). To preserve the site and occlusal plane. Favorable prognosis and the patient has no further symptoms.

(The wing or retainer is dental code D6548 for porcelain. The pontic tooth is dental code D6245 for porcelain.)

Root Canal Tx (Endodontic Therapy): Attachments: pre-op and post-op x-ray

Narrative: Gross decay into the nerve and Root Canal performed unto the pulp and apex of the tooth, all decay removed, build up space will be required. Favorable prognosis and the patient has no further symptoms.

Core Build-up after Root Canal:

Attachments: pre-op and post-op x-ray

Narrative: Build-up required due to previous root canal therapy and tooth structure loss upon removal of decay. Build-up performed to restore occlusal plane and successful final restoration support. Favorable prognosis and the patient has no further symptoms.

Extraction:

Attachments: PA x-ray and BW x-ray

Narrative: Due to Gross Decay [Tooth #] required extraction to preserve sight and surrounding teeth. Favorable prognosis and the patient has no further symptoms. Extraction site to be restored at a later date.

Extraction of Wisdom Teeth (1, 16, 17, 32):

Attachments: Panoramic x-ray

Narrative: Extraction of wisdom teeth number(s) 1,16,17 and 32 due to the patient is having pain/swelling. Teeth are difficult to clean - preventive measures to avoid serious problems in the future.

Bone Graft:

Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray

Narrative: Bone graft placed at site [Tooth #] to preserve the site and occlusal planes for future restoration. Favorable prognosis and the patient has no symptoms.

Extraction and Bone Graft Placement:

Attachments: PA x-ray and BW x-ray

Narrative: [Tooth #] extracted due to extensive decay and non-restorability. Bone graft needed for ridge preservation for future restoration.

Extraction of Primary Tooth:

Attachments: PA x-ray +/or BW x-ray

Narrative: Over-retained [Tooth #] causing inflammation of the gingiva

Membrane:

Attachments: Intraoral photos if possible

Narrative: Barrier use to protect and promote ridge preservation and success of the graft site.

Frenulectomy:

Attachments: Intraoral photos if possible

Narrative: Frenectomy performed increases the range of motion of the tongue and will allow the child to position the tongue normally in the palate. This can help with chewing, swallowing, and speech.

6010 Implant:

Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray + date tooth # was extracted.

Narrative: Implant placed at site [Tooth #] of which was extracted on mm/dd/yyy.

To preserve the site and occlusal plane for future restoration with favorable prognosis. The procedure was medically necessary for patient to chew and masticate food properly. Favorable prognosis and the patient has no symptoms.

Abutment:

Attachments: PA x-ray +/or BW x-ray

Narrative: Custom abutment [Tooth #] placed to restore chewing function in the arch and to retain the integrity of the bone and facial structures.

Denture:

Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray

Narrative: Denture on [Teeth #'s] or Maxillary or Mandibular for the replacement of missing teeth necessary for pt to chew and masticate food properly. [Teeth #'s] extracted on mm/dd/yyyy. ***If replacement denture include the initial date of delivery for prior denture(s).

5820 Interim Partial Denture:

Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray

Narrative: Interim partial denture needed to replace [Teeth #'s]. The patient plans to get an implant placed in the future and the interim partial denture is intended to be in place for the next 12 months. [Teeth #'s] extracted on mm/dd/yyyy.

9920 Behavior Management:

Narrative: The patient is uncooperative and difficult to manage resulting in dental staff providing additional time, skill, and/or assistance to render treatment.

9230 Analgesia:

Narrative: Analgesia needed to reduce anxiety.

Night/Occlusal Guard:

Attachments: Full Mouth Series x-ray(s) +/or Panoramic x-ray

Narrative: Acute bruxism and occlusal wear with head, neck, and jaw pain. Occlusal guard diagnosed with favorable prognosis.

1999 PPE:

Narrative: PPE per levels required by the CDC for transmission-based precautions

ORAL CAVITY CODE GUIDE (used for coding on Dental Insurance Claim Forms)

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Disclaimer:

These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based upon your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, insurance carrier). To the extent Dentistry Support has included links to any third party web site(s), Dentistry Support intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support makes no representations or warranties about the information provided on those sites.

Free Narratives and Attachment Guide for Dental Insurance Claims (2024)

FAQs

What is a narrative for a dental claim? ›

Dental claim narrative for an onlay

Include a periapical and (if available) an intra-oral photo showing the missing or fractured cusp. The restoration must completely cover a cusp to be considered an onlay.

What is a narrative for insurance? ›

Insurance companies often require solid justification for treatment. You can include a brief narrative on insurance claims that describe unusual procedures or services you have performed, or provide clarification about the necessity of certain procedures, which will help you avoid costly claim delays or denials.

How do dental claims process? ›

The dental claims process, similar to medical claims, entails many steps beyond giving care and billing patients.
...
After a patient has visited a dental provider, claims go through several steps before patients receive their final bill:
  1. Billing. ...
  2. Adjudication. ...
  3. Reconciliation. ...
  4. Validation. ...
  5. EOB. ...
  6. Final Billing. ...
  7. Payment.
Jun 2, 2021

What attachments are needed for dental claims? ›

What is supporting documentation on a dental insurance claim?
  • X-rays.
  • Intraoral photos.
  • Clinical notes.
  • Charting.
  • Narratives.
Feb 4, 2022

What do you attach to dental claims? ›

Types of attachments include: X-rays, lab reports, EOBs, narratives, operative reports, nurse and/or doctor notes, periodontal charts and any other document required to process a dental claim.

What attachment needs to be sent with an insurance claim for a crown? ›

With years of claim submission experience, we know which procedures need claim attachments in order for insurance companies to process them upon initial submission.
...
When dental claims need attachments.
Service TypeCommon ProceduresAttachments Needed?
MajorCrowns, build ups, bridges, implants, dentures, partialsYes
2 more rows
Jan 18, 2021

What does assignment of benefits mean in insurance? ›

What is an Assignment of Benefits? An AOB is an agreement that transfers the insurance claims rights or benefits of the policy to a third party. An AOB gives the third party authority to file a claim, make repair decisions, and collect insurance payments without the involvement of the homeowner.

What happens during scaling and root planing? ›

Scaling is when your dentist removes all the plaque and tartar (hardened plaque) above and below the gumline, making sure to clean all the way down to the bottom of the pocket. Your dentist will then begin root planing, smoothing out your teeth roots to help your gums reattach to your teeth.

What does a dental claims processor do? ›

A dental claims processor assesses insurance claims for patient visits to a dentist office. These claims could include any procedure performed by a dentist on a patient's teeth, which might cover everything from essential cleaning to surgical procedures.

What is a clean claim? ›

A "clean claim" means a claim that does all of the following: Identifies the health professional, health facility, home health care provider, or durable medical equipment provider that provided service sufficiently to verify, if necessary, affiliation status and includes any identifying numbers.

What does floating mean in dental insurance? ›

INSURANCE. plural floating policies (also floater) a type of insurance in which the value of the goods being insured cannot be calculated exactly, so the payment for insuring them can be changed after a period of time.

What is dental Code D7241? ›

D7241 removal of impacted tooth - completely bony, with unusual. surgical complications. Most or all of crown covered by bone; unusually difficult or complicated due to factors such as nerve dissection required, separate closure of maxillary sinus required or aberrant tooth position.

What does NEA stand for in dental? ›

National Electronic Attachment (NEA) for Electronic Submission of Dental Attachments.

What is dental Code D6010? ›

The most common of all dental implant procedures is the endosteal procedure. According to CDT, procedure code D6010 includes the surgical placement of the implant body, the second-stage surgery, and the placement of the healing cap.

What is Nea fast attach? ›

Electronically save and send claim attachments — including radiographs and intraoral images, perio charts, EOBs, narratives, pre-treatment estimates, secondary insurance or other documentation — required by a payer. “Prior to FastAttach we had multiple issues in tracking sent information.

What is the current CMS 1500 form? ›

The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of ...

How do I write a letter of appeal for a dental claim? ›

Things to Include in Your Appeal Letter
  1. Patient name, policy number, and policy holder name.
  2. Accurate contact information for patient and policy holder.
  3. Date of denial letter, specifics on what was denied, and cited reason for denial.
  4. Doctor or medical provider's name and contact information.
Jul 7, 2022

What are the consequences of sending unnecessary information when filing an insurance claim form? ›

What are the consequences of sending unnecessary information when filing an insurance claim form? Processing of the form will be delayed. Most dental offices require the patient to submit his or her own dental claims to their insurance companies for payment.

What is dental Code D2954? ›

A prefabricated post and core (D2954) is a standard (out-of-the-box) post, and it typically comes in various sizes. A standard post will be placed if the size and fit are perfect to stabilize the tooth without the need of a dental laboratory fabrication. Most dental practices will use this method.

Why is assignment of benefits not recommended? ›

Loopholes in the way AOB is being used are enabling contractors and restoration companies to abuse the practice by inflating claims costs and charging insurance companies for work that was either unnecessary or simply wasn't done at all. These fraudsters then keep any extra money for themselves.

What is the difference between accept assignment and assignment of benefits? ›

To accept assignment means that the provider agrees to accept what the insurance company allows or approves as payment in full for the claim. Assignment of benefits means the patient and/or insured authorizes the payer to reimburse the provider directly.

What happens when a claim is rejected? ›

A rejected claim can be resubmitted once the errors have been corrected since the data was never entered into the system. These types of errors will prevent the insurance company from paying the bill and the rejected claim is returned to the biller to be corrected.

How long does it take for gums to heal after scaling and root planing? ›

This is normal and expected, and should subside within 7-14 days. If you have any questions about plaque-control recommendations, please do not hesitate to contact our office. SENSITIVITY: Commonly after gum treatment, the tissue shrinks and the root surface is exposed.

How many units of scaling is normal? ›

Scaling typically has a reasonable and customary rate of 6-8 units per person, per year, but your dental insurance provider will be happy to confirm what your plan includes.

Is Deep cleaning painful? ›

Deep teeth cleaning can be uncomfortable, but it shouldn't be painful. You dentist will give you a local anesthetic, either in the form of a gel or an injection, so you shouldn't feel any pain during the procedure.

What is the main goal of a claims processor? ›

A Claims Processor is responsible for processing and verifying insurance claims, in adherence to the policies, laws, and regulations of the company involved. Aside from examining its authenticity, they must also oversee new policies and recommend modifications should it be needed.

What is involved in claims processing? ›

How Does Claims Processing Work? After your visit, either your doctor sends a bill to your insurance company for any charges you didn't pay at the visit or you submit a claim for the services you received. A claims processor will check it for completeness, accuracy and whether the service is covered under your plan.

Which limits patients to a predetermined list of dentists? ›

Theory Ch. 12, 14, 15 *Gaylor* TEST
<script id=Definition
An account aging report can be described as:an analysis of the length of time that has elapsed since a charge was made.
Of the following dental plans, which limits patients to a predetermined list of dentists?Managed, HMO, and EPO
23 more rows

What is a dirty Claim? ›

The dirty claim definition is anything that's rejected, filed more than once, contains errors, has a preventable denial, etc.

What is code scrubbing? ›

Claim scrubbing is a service offered by third parties to healthcare providers. Its primary purpose is to detect and eliminate errors in billing codes, reducing the number of claims to medical insurers that are denied or rejected.

What is a good clean Claim rate? ›

Submitting clean claims means the claim spends less time in accounts receivable, less time at the payer, and the laboratory or other diagnostic provider gets paid faster. Experts across the industry agree that a clean claim rate should exceed 90 percent.

What does FPC mean in dentistry? ›

Abbrev. for Family Practitioner Committee.

What does TX mean in dental terms? ›

Tx – Treatment. UL – Upper left quadrant. Also called Quadrant 2.

Which of the following is excluded in a dental insurance plan? ›

Dental plans typically exclude cosmetic services (unless required by an accident), replacement of lost dentures, duplicate dentures, oral hygiene instruction, occupational injuries covered by workers compensation, or services provided by government agencies.

What attachment needs to be sent with an insurance claim for a crown? ›

With years of claim submission experience, we know which procedures need claim attachments in order for insurance companies to process them upon initial submission.
...
When dental claims need attachments.
Service TypeCommon ProceduresAttachments Needed?
MajorCrowns, build ups, bridges, implants, dentures, partialsYes
2 more rows
Jan 18, 2021

What does assignment of benefits mean in insurance? ›

What is an Assignment of Benefits? An AOB is an agreement that transfers the insurance claims rights or benefits of the policy to a third party. An AOB gives the third party authority to file a claim, make repair decisions, and collect insurance payments without the involvement of the homeowner.

What happens during scaling and root planing? ›

Scaling is when your dentist removes all the plaque and tartar (hardened plaque) above and below the gumline, making sure to clean all the way down to the bottom of the pocket. Your dentist will then begin root planing, smoothing out your teeth roots to help your gums reattach to your teeth.

What type of service is occlusal guard? ›

Description of Services

Occlusal guards are fabricated from rigid or semi rigid/soft materials to cover teeth to protect them from bruxism and clenching of teeth. They may be constructed in the dental office or by an outside laboratory.

How do I write a letter of appeal for a dental claim? ›

Things to Include in Your Appeal Letter
  1. Patient name, policy number, and policy holder name.
  2. Accurate contact information for patient and policy holder.
  3. Date of denial letter, specifics on what was denied, and cited reason for denial.
  4. Doctor or medical provider's name and contact information.
Jul 7, 2022

What are the consequences of sending unnecessary information when filing an insurance claim form? ›

What are the consequences of sending unnecessary information when filing an insurance claim form? Processing of the form will be delayed. Most dental offices require the patient to submit his or her own dental claims to their insurance companies for payment.

What is dental Code D2954? ›

A prefabricated post and core (D2954) is a standard (out-of-the-box) post, and it typically comes in various sizes. A standard post will be placed if the size and fit are perfect to stabilize the tooth without the need of a dental laboratory fabrication. Most dental practices will use this method.

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