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Dental Predeterminations

A dental predetermination is an itemization of proposed dental charges and their reimbursements before dental services are performed. It should not be confused with certification. A predetermination is not required, but is recommended when the dental treatment plan proposed by the provider is expected to exceed $200. A predetermination also shows the financial liability of the member. It should be identified as a predetermination and submitted in the same manner as a standard paper dental claim or HIPAA 837 electronic claims submission.

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