All dental procedures/consultation require prior approval from Nextcare
Dental benefit coverage usually has a limit per year, please always check or ask about your dental limits
Dental benefits vary according to your insurance coverage plans, please check your poicy details using Nextcare App
Always ask about your dental benefits or check using Nextcare App about copayment on dental services before visiting your dentist
There is no need to do the dental consultation first then the procedure after few days unless medically required
Approval for dental services is usually granted within 20-30 minutes from the time your healthcare provider submits the request to Nextcare
Cosmetic dental procedures are usually not covered, please check your policy
For Healthcare Providers
All Dental procedures require Pre-Authorization from Nextcare
Dental consultation should not be billed when a procedure is performed
Each dental procedure performed requires patients signature on the rendered service document on the date of service rendered
Specifying the tooth number electronically where applicable
Only the initial (diagnostic) x-ray can be billed for treatment. Intra-operative x-rays are considered part of the overall service billing and can not be billed for the patients
Coverage is allowed only when a tooth cannot be restored with a composite filling
Onlays are only covered for posterior teeth
An x-ray is required for evaluation of the below requests:
Root canal treatment
Impacted teeth extractions
Core build up
Provisional/temporary crowns are not to be billed separately with routine permanent crowns
Core build up:
Allowed when there is severe destruction of the tooth structure (more than half the crown is destructed)
Cannot be billed with composite filling/inlays/onlays for the same tooth
Pulp capping can not be billed when used as liner under a permanent filling
Pulpectomy and temporary fillings can be billed separately only in cases of emergency procedure for pain relief
Scaling root planning: A periodontal chart with pocket depth or x-ray showing bone loss is required for approval
RCT procedure includes pulpectomy and temporary filling
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