Some dental treatments require prior authorization.
Your insurance company wants to review the treatment plan before you start. If you do not get pre-auth, the claim gets denied. You have to resubmit. Payment is delayed. Patient is upset.
Pre-authorization is administrative, but it is critical.
Which Treatments Usually Require Pre-Auth
Major restorative: Crowns, bridges, implants. Often require pre-auth.
Orthodontics: Braces require pre-approval and often age limitations.
Surgical: Extractions (sometimes), bone grafts, implant placement.
Cosmetic: Whitening, veneers. Usually no pre-auth required.
Expensive treatment: Some plans require pre-auth for any treatment above $1,000.
Insurance varies. Some plans require pre-auth for everything. Others for nothing. You have to know.
The Pre-Auth Process
Step 1: Identify that treatment requires pre-auth.
During treatment planning, ask the insurance company: “Does this treatment need prior authorization?”
Step 2: Get treatment code and cost estimate.
Dentist codes the planned treatment. You estimate cost based on your fees.
Step 3: Submit pre-authorization request.
This includes: patient info, treatment codes, dentist license number, treatment rationale, cost estimate. Some require radiographs or treatment plans.
Step 4: Insurance reviews and approves or denies.
Approval takes 3-10 business days typically.
Step 5: Document approval and proceed.
Once approved, you have authorization to proceed. Keep the approval number. Reference it on the claim.
Step 6: Submit claim after treatment.
When treatment is complete, submit claim with the pre-auth approval number. Claim is processed faster and correctly.
Common Pre-Auth Mistakes
Assuming pre-auth is not needed: You submit treatment. Claim is denied. You have to resubmit with pre-auth.
Submitting incomplete pre-auth: Insurance needs more information. Approval is delayed. Patient is delayed. You reschedule.
Not documenting the approval: You get approval verbally. Days later you cannot find the approval number. You argue with insurance about whether it was approved.
Submitting before approval: You complete treatment before getting pre-auth. Claim is denied. Patient is upset.
Not updating the plan: You get pre-auth for a crown. During treatment, you discover the tooth needs endo too. You did not get pre-auth for endo. Now there are two procedures, one is not approved.
Reach Handles This
Reach places a dedicated team member trained in pre-auth workflows. They:
- Identify when pre-auth is needed
- Gather required information from the dentist
- Submit pre-auth requests
- Follow up to ensure approval
- Document approval in the patient chart
- Alert the dentist when approved
- Flag any issues or denials
Your practice stays on schedule. Approvals do not get lost. Claims get approved.
AI-Amplified Authorization
HIPAA-grade AI tools show:
- Which insurance plans require pre-auth for which procedures
- Pre-auth submission templates (saves time, reduces errors)
- Approval tracking (AI alerts when approval is needed)
- Claim submission (AI ensures pre-auth number is included)
FAQ
**Q: How long does pre-auth take?**
A: Usually 3-10 business days. Some urgent cases are approved faster.
**Q: What if pre-auth is denied?**
A: Insurance is saying they will not cover this treatment. You can appeal, or discuss alternative treatment with the patient.
**Q: Can the patient have treatment without pre-auth?**
A: Yes. But if insurance denies the claim, the patient may be responsible for the full cost.
**Q: Who pays if pre-auth is denied?**
A: Insurance will not pay. The patient is responsible unless the practice writes off the cost.
**Q: How do I track pre-auth status?**
A: Keep approval numbers, dates, and documentation. Follow up 5 days after submission if not approved.