Dental Practices and Letters of Medical Necessity

One of the most common things dentists struggle with when prepping medical claims is providing the right documentation. Among those are letters of medical necessity. These are much more involved than the standard narrative. These letters are often the best way to provide the medical rationale for treatment.

What to include in letters of medical necessity

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 include 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, the expected duration of treatment, and if multiple visits will be required. The letter should end with a summary of the reason for the recommended or performed treatment. Make sure you include references to any referring providers or related tests completed outside your office.

No “cookie cutter” letters

“Cookie cutter” letters should be avoided if possible. Ensure your letter is unique to your patient and their treatment so the claims reviewer understands its importance. Canned narratives and letters end up 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.

If you are struggling with dental billing consider partnering with eAssist. Our Success Consultants are knowledgeable about claims documentation and will ensure your claims are billed correctly. To learn more, schedule a consultation here.

Dr. James V. Anderson

CEO & Co-Founder, eAssist

Dr. James Anderson is a practicing dentist and the CEO and Co-Founder of eAssist Dental Solutions, the nation’s leading platform for dental billing. A serial entrepreneur, Dr. Anderson has built multiple successful ventures, including eAssist and nine dental practices in Utah, all driven by his mission to help dentists, their teams, and their patients achieve peace of mind. He co-founded eAssist in 2011 to give dental practice owners the ability to fully outsource their billing departments—a vision that now serves over 2,400 practices nationwide. Under his leadership, the company has formed strategic partnerships with the California Dental Association and Henry Schein, and earned a spot on the Inc. 5000 list for nine consecutive years. In 2020, Dr. Anderson was recognized as Entrepreneur of the Year by Business View Magazine and ranked among the top entrepreneurs in the country by Entrepreneur Magazine. He holds a B.S. in Finance from Brigham Young University, a D.M.D. from Oregon Health & Science University, and completed the three-year O.P.M. program at Harvard Business School. He also serves as Chairman of the Dental MBA Advisory Board at Roseman Dental School.