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The following is a list of frequently asked questions. If you don’t see your question or need more explanation, contact us we will get back to you as soon as we can. Thank you!
This is my first claim submission to NADENT. I need help. What do I do?
We have now simplified the submission process. All dental claims are now being submitted to the Fort Collins, Colorado address. However, you can click here to see which states fall into what region.
Click here to go to the claims form options to fill out and submit. Be sure to fill in all of the needed information (your information, the claimant’s information, and which type of review you would like us to perform) and click “Submit.”
If you are still confused or unsure about what to do, feel free to contact us for assistance.
What are the differences between the types of reviews?
A Full Review includes a review of dental chart notes (before and after the incident when available), x-rays, charges, and Treatment Plan. Copies of an accident or incident report are also helpful. If the claimant was seen in an ER or medical facility, those records are also helpful in completing the review. Our consultants review all information submitted to determine what conditions, if any, are related to the accident, as well as determining if the treatment is appropriate and necessary, if there are betterment issues, and if the fees fall within a reasonable amount, or fall within an appropriate fee schedule.
A Fee Audit is a review limited to determining appropriateness of fees. Typically this is when the claim examiner is not questioning causality and is only concerned about appropriateness of fees.
A Physical Examination or IME (Independent Medical Exam) is just that – for purposes of providing a closer look by one of our consultants at the conditions in the claimant’s mouth. For more information go to our services.
Why do you request the claimant’s prior records?
Prior records are helpful in determining what conditions were pre-existing, or if the claimant was previously advised of the need for treatment that is listed in the claim.
When can I expect to get a decision/report back?
NADENT will, in most instances, complete a written review/report for you within two weeks of the time we receive all necessary information from the treating dentist. If all needed information is not submitted with the claim we will submit a request for additional information (provided an Authorization to Release records has been submitted to NADENT, or the treating dentist has one on file) and let you know of this request. Depending upon how long it takes to obtain that information this will add to the total time required to complete the review.
What if I need the claim done by the end of the week?
This is not a problem! Just be sure to write in the comments section or check the box to let us know that the claim is a RUSH and we will try to expedite the review as best we can. You can also call the office ahead of time and let us know it’s on its way.
What is dental trauma review?
Dental trauma review is a process of reviewing patient records to determine exactly what damage could be trauma related, versus what conditions are pre-existing or not related to the incident. It is becoming more and more popular because of many claims turning out to be fraudulent and costing insurance companies an extensive amount of money for work that might not even be accident related.
How much do you charge for a review?
We are happy to send you (by fax, email or mail) a complete fee schedule listing the usual range of fees for each service we provide. Please contact us to request a current fee schedule. For more information go to our services.
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