Imagn Billing Case Success Story

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Medical Billing For Orthodontic Treatment.

The Orthodontic Case Overview

What follows are the details for this Imagn Billing case success story about medical billing for orthodontic treatment.  Read on to learn how a dental practice in Washington state successfully billed for orthodontic treatment. The practice completed this service March 11, 2020, and submitted the case to our Imagn Billing team November 5, 2020. On March 25, 2021, the insurer, Tricare West – HealthNet Federal Services, initially denied the claim. The Imagn team appealed the insurer’s decision on August 3, 2021.  Then, on September 15, 2021, the medical claim was paid at 100% of allowable

The Case Details

An 18-year-old male patient presented for an evaluation foA. HPI (history of present illness) patient has had increase in malocclusion with more hypoplasia. The oral physician notes that due to the medical conditions, orthodontics is required to prepare for the additional facial surgery.

Proving Medical Necessity

As noted in the providers SOAP note:
  • History of recurring pain and malocclusion
  • Facial Bipartition Surgery
  • Midface hypoplasia

Billing Medical Insurance

The practice collected all required documentation and clinical SOAP notes .  (Course on SOAP notes is available free by Devdent.) The pre-authorization on medical billing for orthodontic treatment was completed and approved.

Allowable was $5,267.68. Total collected from patient and insurance $5,267.68.  $0 applied to deduct, $0.00 applied to co-insurance.  Dental insurance paid $0.00.  Patient portion $0.00.

The medical insurance paid 100% of the orthodontic treatment.  This patient’s parents were ecstatic that the provider obtained these medical benefits. Otherwise, the funds would have had to come out of their pocket.  Instead, medical billing for orthodontic treatment paid 100% of the services provided.

At Devdent, we are passionate about guiding dental and orthodontal practices on how to be paid for the great services they provide.  We offer access to live, on-site, and online educational courses on correct submission of dental and orthodontic treatment claims to medical insurance when appropriate.  And we’ll let you in on a little secret:  it is almost always appropriate. 

Imagn Billing offers software, forms, other tools and personal support to complete the claims properly and timely.  The end result is that your practice increases case acceptance so you can get paid for the work you do.  Talk to one of our experts to learn more.

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