Dental narratives explain to insurance companies why they should accept claims. When your patient needs dental treatments beyond their standard covered services, you must provide documents and supporting explanations detailing why a given procedure will improve the patient’s health. Many dental care practitioners feel overwhelmed by writing narratives.

At Dental Intelligence, we help dental practices improve their internal operations for optimal patient and team experiences. Our software also helps you easily collect payments for dental services without wasting precious resources. Continue reading below to learn our top six tips on writing dental narratives for insurance claims.

1. Understand Coverage Inclusions and Exclusions 

Before writing narratives, determine what the insurer will or will not cover. For example, most organizations cover two standard cleanings per year, so you shouldn’t waste time writing narratives for services included under this umbrella. 

Insurers often state which treatments they don’t cover. A few common examples include the following:

• Attrition (tooth structure wear and tear)
• Abrasion (tooth damage from brushing)
• Abfraction (tooth damage from traumatic forces)
• Erosion (gradual tooth destruction from products or poor hygiene)

Using the above terms in your narrative will likely result in a denial from many companies. Learning what you can and cannot say to insurers can help you improve success rates. 

2. Skip the Prewritten Templates 

Stock dental narratives may seem the quickest and easiest solution, but they don’t adequately display the patient’s needs. A narrative should tell the patient’s full story, including the context surrounding their problem, potential future complications, symptoms, etc. You will not find such specific details in prewritten templates. 

Stock narratives typically use vague information that may not relate to your patient’s needs. Such inaccuracies can lead to denials and fraud claims. To maintain your practice’s reputation and claim approval rates, you should write each narrative individually. 

3. Keep the Narrative Concise and Informative 

While you want to discuss the patient in detail, you don’t need to tell their whole life story. Only include the most relevant information relating to the claim. The narrative should generally cover the “who, what, when, where, and why” supporting the patient’s medical necessity. 

For example, the narrative for a ceramic crown may include the following details:

• Existing crown placement (if replacing) details with date and reason for replacement
• The pathology report on the tooth’s condition
• A detailed cosmetic explanation (when appropriate)
• The amount and location of decay
• Any past or planned root canals
• The prior filling restoration size
• The estimated amount of tooth remaining after decay removal
• The remaining tooth structure condition
• Fracture notes
• Additional diagnoses, like cracked tooth syndrome
• Tooth periodontic and endodontic prognoses
• Patient symptoms or chief complaints
• Radiographic images
• Intraoral images
• Prep and complete dates

4. Add Context to the Evidence

Insurers cannot look at an x-ray of a broken tooth and understand why the patient would need treatment. You must explain the context behind all attached evidence, translating what the information indicates and why it proves that the patient’s health depends on the requested service. 

When explaining context, focus on tooth functionality and future complications if not fixed. Try to include specific figures, like decay percentages and estimates, for the most detailed explanation possible. 

5. Avoid Mentioning Cosmetic Problems

Most insurers won’t accept claims for cosmetic issues. For example, if the patient cracks a front tooth and wishes to fix it, you may need to consider functional reasons that can improve the claim’s acceptance likelihood. For a cracked tooth, you could explain how the patient has pain, trouble chewing foods, and a general lack of functionality rather than discussing how their smile looks. 

6. Keep It Professional 

Before submitting your claim, you want to ensure it sounds professional and legitimate. We recommend the following tips:

• Avoid abbreviations and slang words
• Do not handwrite the narrative
• Spellcheck the document for errors
• Add all supporting evidence in downloadable formats
• Attach digital clinical notes when appropriate

Get Paid Faster With Dental Intelligence

Crafting successful dental narratives improves claim acceptance rates, patient outcomes and satisfaction, and practice revenue streams. At Dental Intelligence, we want to help you learn how to get paid faster. Our comprehensive software automates the payment collection process with seamless digital experiences that your patients and team will love.

Schedule a demo with Dental Intelligence today to see how our platform can transform your dental practice.