Definition
Dental Predetermination refers to submitting a proposed treatment plan to a dental payer for a pre-treatment estimate of coverage and patient cost; it is not a guarantee of payment. Submissions typically include CDT codes and required attachments (e.g., radiographs, perio charting). Example: a crown predetermination may return 50% coverage up to a $700 maximum, indicating an estimated $350 patient responsibility; many payers respond within 7–14 days, faster when sent electronically with complete attachments.
Why it matters
For DSOs, accurate predeterminations improve case acceptance and reduce surprise balances and refunds across hundreds of providers. A 5-point lift in case acceptance on $100M in annual production can add $5M in approved treatment while lowering call-center time tied to financial rework.
How Ventus helps
Ventus assembles predetermination requests to each payer's requirements, with codes, attachments and a narrative, and follows them until the payer returns a determination. The result and its reference number are written back into the practice management system.
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