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Jan 1, 2013 ... A predetermination of benefits is recommended for costs that are expected to ..... Dental benefits payable under a Company medical plan.
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What is a predetermination of benefits?
A predetermination of benefits is a process where a healthcare provider submits a request to an insurance company for an estimation of how much they will cover for a specific medical service.
Who is required to file a predetermination of benefits?
Healthcare providers are typically required to file a predetermination of benefits before performing certain medical procedures to ensure coverage and avoid surprises for patients.
How to fill out a predetermination of benefits?
To fill out a predetermination of benefits, healthcare providers need to submit a form to the patient's insurance company with details of the planned medical service and ask for an estimate of coverage.
What is the purpose of a predetermination of benefits?
The purpose of a predetermination of benefits is to give both healthcare providers and patients a clear understanding of how much an insurance company will cover for a specific medical service.
What information must be reported on a predetermination of benefits?
Information such as the procedure to be performed, medical codes, patient information, and provider details must be reported on a predetermination of benefits.
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