Insurance term
Claim Narrative
Definition
A claim narrative is a short written explanation sent with a claim to show why a procedure was needed.
Why it matters for the front desk
Payers often ask for narratives on crowns, buildups, scaling and root planing and other procedures they review closely. A good narrative is specific to the tooth: what was found, how much structure was missing, and why a less costly option wouldn't work. Vague or copied text is a common reason for denial. Matching the narrative to the attached x-rays and photos saves a round of appeals.
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Related terms
- Preauthorization (Predetermination) A preauthorization, usually called a predetermination or pretreatment estimate in dentistry, is a request sent to the payer before treatment asking what it will cover.
- CDT Code A CDT code is a five character procedure code (the letter D followed by four digits) from the Code on Dental Procedures and Nomenclature, maintained by the American Dental Association.
- EOB (Explanation of Benefits) An EOB is a statement from the insurance payer that explains how a claim was processed: what was billed, allowed, paid, adjusted and left for the patient.