Get Dental Pre-authorisation Request Form

Predetermination is not the same as pre-authorization. “Pre-authorization” is a required process for the doctor to get approval from BCBSIL before you are admitted to the hospital for routine care. Pre-authorization is also called “pre-certification” or “pre-notification.”

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.

Dentists use the pre-authorization process to determine a patient's coverage. Sometimes a treatment plan has been pre-authorized or pre-approved by the carrier and the treatment is performed by the dentist with the expectation that the claim will be paid, but it is denied.

Predetermination––sometimes called a pre-estimate of benefits or pretreatment estimate––provides confirmation that the patient is indeed a covered enrollee of the dental plan. It also verifies that the proposed treatment is a covered benefit for this patient.

What is supporting documentation on a dental insurance claim? X-rays. Intraoral photos. Clinical notes (examples below) Charting. Narratives.

The prior authorization process gives your health insurance company a chance to review how necessary a medical treatment or medication may be in treating your condition. For example, some brand-name medications are very costly.

This authorization is simply to tell you whether or not the patient's policy covers a specific treatment, but it does not tell you how much coverage they have. Once you receive preauthorization, you can then complete request to receive more specific information about their coverage this is the predetermination.