Page 128 - 2021 AGD ADVOCACY
P. 128
Prior Authorization
Upon request of either the dentist or patient, a plan/ insurer must provide
written prior authorization of benefits
Prior authorization is defined as written and verifiable determination that
one or more specific dental care services are covered and reimbursable in
a stated specific amount
The plan or policy provider could not deny a claim or pay less than the
stated amount except in certain circumstances including if the patient ‘s
benefit limitations were exceeded and documentation for the claim was
not sufficiently the preauthorized service was not medically necessary
