Tuesday, August 29, 2017

Requiring a Pre-Authorization for Specific Procedures

Updated 10/7/2019

Occasionally, insurance companies require you to submit a pre-authorization for a procedure before the work is completed. Because these requirements vary from insurance company to insurance company, you can manipulate the coverage table for each insurance company in Dentrix and mark the procedures that require pre-authorizations.

How To:

  1. In the Office Manager, select Maintenance > Reference > Insurance Maintenance.
  2. Highlight the insurance plan you want to update, and click the Coverage Table button.
  3. Select the procedure (or procedure category) that requires a pre-authorization.


  4. Check the Pre Auth checkbox and then click Change. A “Y” will appear in the Pre Auth column. When that procedure is treatment planned for a patient, a notation is added to the Treatment Plan view of the Ledger and the Case Detail view of the Treatment Planner.
  5. Click OK to save the changes.

Additional Information

  • You should make it a habit to update the coverage table when insurance companies notify you of procedures that require pre-authorization. Then as procedures are treatment planned for patients, double-check the Treatment Planner view of the Ledger for which procedures need authorized before treatment.
  • In the Treatment Planner, click View > Procedure Information and make sure that the PreAuth option is checked. Then when you use the Treatment Planner Case Detail view, you will be able to see whether a pre-authorization is needed before you complete the procedure.
  • When viewing the Treatment Plan view in the Ledger, procedures needing pre-authorization display the following information in the Ins column to indicate what kind of pre-authorization is required:
    • 1** - Indicates primary insurance requires a pre-authorization on that procedure.
    • 2 - Indicates secondary insurance requires a pre-authorization on that procedure.
    • 1*2 - Indicates both primary and secondary insurance require a pre-authorization on the procedure.
    • NO - Indicates neither insurance requires a pre-authorization on the procedure.

To learn more, log in to the Dentrix Resource Center and read article #22873 Applying Insurance Pre-Estimate Flags in the Dentrix Knowledgebase.

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