Using an accurate estimate of the minutes needed for a dental anesthesia procedure will help avoid underestimated prior authorization requests and potential claim denials. When you submit the medical claim, we use the number of units from your prior authorization to calculate the payment amount.
How to correctly submit units
A medical prior authorization for a dental anesthesia procedure must include an accurate estimate of the number of minutes the procedure will take. The number of units on the claim must equal the expected number of minutes on the prior authorization. We won’t adjust the number of units.
Example of an incorrect submission
If you submit a prior authorization with a time unit of “1,” we’ll calculate the claim using “1” as the unit number, regardless of what’s entered on the submitted claim. If the unit is “1” on the prior authorization and the per-unit rate is $5.12, we’ll pay the claim at $5.12.
How to request a medical prior authorization
Submit a request using one of the following methods: