I need some dental work done. I received a quote from my dentist with CPT codes and I faxed this to Humana Claims but I have not heard anything back about it
A pre-determination is best described as a "pre-claim". Basically the provider submits the dental services as if they were doing a standard claim submission. They would include the service and diagnosis codes. Once received by Humana, we will determine dental necessity, as well as give an estimate of how much your potential out of pocket expenses will be, dependent on your dental policy.
I confirmed we have received your documentation and it is in review.
These usually take 30 days to process, and once complete, you and the provider will receive an explanation of benefits.
We usually suggest have a pre-determination submitted for dental services that are expected to be over $300.00.
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