Practices can create preauthorizations, similar to a claim, to send to insurance prior to completing any treatment in order to get an estimate of what is covered under a patient's insurance plan.

In the Treatment Plan Module, with desired procedures selected, click PreAuthorization.

A preauthorization is very similar to an insurance claim, except that when it is sent, the date of service is left blank. The insurance company reviews the procedures sent and decides whether they are covered under the patient's contract. Insurance then sends back a form with an estimate of how much is expected to be covered for each procedure.

The Edit Preauthorization window is similar to the Edit Claim window. For details on fields, see Claim.

Create a Preauthorization

1. In the Treatment Plan Module, highlight one or more procedures.
2. In the Toolbar, click PreAuthorization.
   If there is more than one active plan, the Select Insurance Plan window opens:
   
   Select the plan the preauthorization is for, and the relationship of the patient to the plan subscriber, then click OK.
   • Show plans for family which are not in use by the current patient: Check to list all insurance plans for the family, including inactive or dropped plans
3. A preauthorization is created for the selected procedures.
4. Print or send the preauthorization electronically. Once sent, only users with the PreAuth Sent Edit permission can make edits.

Other Coverage: If other coverage (e.g., secondary coverage) needs to be included when sending the preauthorization, Click Change next to Other Coverage and verify the Relationship to Subscriber. This option can also be used to set primary coverage if this is a preauthorization to a secondary insurance plan. If primary has already been received with no other coverage selected, send a new preauthorization for the secondary insurance only.

Manage Preauthorizations

Preauthorizations for a patient are listed in the top right of the Treatment Plan Module. When a user clicks on a preauthorization, all procedures attached to that preauthorization are highlighted for easy viewing.

Double-click a preauthorization to view details.

Use this grid to check the status of a preauthorization or use the Outstanding Insurance Claims Report.

Receive a Preauthorization

When the preauthorization comes back from insurance:

1. Double-click on the preauthorization.
2. Click By Procedure in the upper-right corner.
   
3. In the Estimate column, enter estimates given on the EOB.
4. In the Remarks column, enter the preauthorization number and any remarks sent by insurance.
   • When the claim is created, in the Edit Claim window, enter the preauthorization number in the Predeterm Benefits field as well.
5. Optionally, click Scan EOB to scan or import the EOB to the preauthorization. The Scan EOB window opens.

Estimates are added as overrides to the insurance estimate Claim Procedures ( claimprocs ) and are reflected in Treatment Plan estimates.

Alternatively, receive preauthorizations via ERAs to update estimates.

Attachments

Attachments can be added to preauthorizations as needed. If sending attachments using DentalXChange, right-click a preauthorization from the Treatment Plan Module, Pre Authorizations grid for attachment options. If using EDS or NEA/Manual attachments, go to the Attachments Tab in the preauthorization to add attachments.

Estimated Patient Portion / Patient Responsibility

Estimated write-offs cannot be entered when receiving a Preauthorization.

If Show Patient Responsibility column in the Edit Claim/Payment windows is enabled in Preferences, the estimated patient portion displayed on a preauthorization may be higher than the actual patient portion if there are estimated write-offs or if the patient has other insurance coverage. The PatResp column is designed to show patient responsibility when receiving a claim.

Reference the Treatment Plan Module for the Pat estimate or the Claim Procedures ( claimprocs ) for Estimated Patient Portion instead.