Maximizing Endodontic Claim Success: A Practical Guide to Writing a Strong Dental Narrative

As the second installment in the AAE’s quarterly series on coding and reimbursement, this article explores practical strategies for writing strong dental narratives to support claim submissions and reimbursement outcomes.

Navigating dental benefits is an important part of practice management. Submitting a clear dental narrative is a key component during the insurance submission to make sure that your claims are approved upon the first submission. Additionally, a dental narrative may be requested from an insurance carrier when an insurance claim involves major or extensive dental treatment.

Tips for Submitting a Strong Dental Narrative

1. Understand the dental benefit plans coverage inclusions and exclusions. Do not spend time and energy writing extensive narratives that will be denied based on the plan’s policy. Insurances are upfront about procedures that are not covered benefits. This information is readily available through the online portals. Alternatively, a verbal breakdown of the patient’s insurance benefits can be determined by speaking with the insurance carrier directly. Keep in mind these phone calls have long wait times. It may be wise to invest the time to train your administrative staff how to access each carrier’s online portals to be more productive.
2. Customize each narrative to accurately explain the procedure in question. Prewritten dental narrative templates often result in denials. Templates tend to provide vague details and do not expertly narrate the procedure. A narrative should explain the patient’s dental problem and the procedural solution with factual evidence. Although writing individual narratives for each claim is time consuming, taking the extra steps and time to do so will results in a higher acceptance rate.
3. Narratives should be succinct. You want to relay all relevant information to support your claim. Stick to the “who, what, where and why.” For example, a narrative for a non-surgical retreatment may include the following details:
   1. Date of initial root canal therapy
   2. The current condition of the tooth; restorative history, location of caries
   3. Pulp testing
   4. Description of a periapical lesion
   5. Endodontic and periodontic diagnosis
   6. Patient’s chief complaint or symptoms
   7. All radiographic imaging
4. Add context to support the treatment provided. Explain to the insurer that failure to provide the procedure performed may result in future complications. Support your procedural decision with evidence-based facts such as non-surgical retreatment success rates.
5. Always maintain professionalism. Proofread your narrative before submission. Do not abbreviate words or use catch phrases unfamiliar to a dental insurer. Attach all supporting documentation in the proper downloadable format to avoid further delays. This includes but is not limited to imaging and digital clinical notes.

Dental Narratives are not a guarantee that a claim will be approved and processed. However, a well prepared narrative remains an important part of the insurance submission process and can greatly speed up the reimbursement process.

Dental narratives are not a guarantee that a claim will be approved and processed. However, a well-prepared narrative remains an important part of the insurance submission process and can greatly speed up the reimbursement process.

Questions for Our Coding Experts?

The AAE Practice Affairs Code Maintenance Committee welcomes questions from AAE members related to CDT coding and reimbursement education. Members may contact advocacy@aae.org with coding-related questions.