What is dental pre-authorization?

Pre-authorization — sometimes called pre-determination or prior authorization — is a carrier's advance review of a proposed treatment. The practice submits the planned procedure, often with supporting documentation like x-rays or periodontal charting, and the carrier confirms whether it will be covered and at what level before the work is done.

It is most often required for major procedures: crowns, bridges, implants, dentures, orthodontics, and periodontal surgery. Requirements vary widely by carrier — some require pre-auth on procedures that another carrier approves automatically — which is why the requirement has to be confirmed per plan during verification, not assumed.

Skipping a required pre-authorization is one of the most common and least recoverable causes of denial. Unlike an eligibility error that can sometimes be corrected and resubmitted, a missing pre-auth on a completed procedure often cannot be fixed after the fact — the carrier's position is that it was never given the chance to review.

Pre-authorization frequently overlaps with other policy checks on the same claim. A crown on a tooth may need pre-auth and also run into a waiting period, while an implant may need pre-auth and hit a missing tooth clause. Capturing all of these together is what a full breakdown is for.

Note that a pre-authorization is not a guarantee of payment — it is an indication based on the information available at the time, still subject to eligibility and remaining benefits on the date of service. But obtaining it, and documenting it, dramatically reduces the risk of a denied claim on expensive work.