James Anderson

Dental Practices and Letters of Medical Necessity

One of the most common things dentists struggle with when prepping to send medical claims is providing the right documentation. Among those are letters of medical necessity. Not something we ever get requests for from dental carriers and much more involved than the standard narrative. These letters are often times the best way to provide the most information to the claims analyst as well as provide the medical rationale for treatment.
Letters should first contain the name of the patient, insurance ID number, date of birth and the date of service in question. The first paragraph should also speak to the patient’s health history and current diagnosis that justified the procedure(s).
The letter should go on to detail the treatment recommended or rendered, the treatment rationale and the expected duration of treatment if multiple visits will be required. The letter should end with a summary of the medical rationale behind the recommended or performed treatment. Make sure you include references to any referring providers or tests the patient may have had done in relation to the procedure from outside your office.
“Cookie cutter” letters should be avoided if possible. Make sure your letter is unique to your patient and their treatment so that the claims reviewer understands how important the treatment is. Canned narratives and letters end up sounding lacking in clinical data. The best letters of medical necessity speak clearly to clinical, empirical data and do not leave room for doubt or conjecture as to whether the treatment was truly necessary.


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