Helpful Claim Processing Tips for Aetna Participating Providers
These tips are provided on behalf of Aetna.
Members should contact Aetna directly with any questions about these tips or other claim processing issues.
Submissions requiring clinical review may be delayed by containing incorrect or missing information. These tips can expedite the review process:
- Avoid invalid or incorrect codes by using the appropriate and valid CDT code (CDT 2011-2012, American Dental Association ©2010) when reporting dental treatment. CDT 2011-2012 reflects the most recent version of the code that has been effective since January 1, 2011.
- Submissions for a periodontal procedure that does not include a full quadrant: include tooth numbers for the teeth involved in the procedure.
- Submissions for prosthodontics: include the numbers of all other missing teeth in the same arch.
- Submissions for initial placement of a denture or bridgework: include the date the tooth or teeth were extracted.
- Submissions for replacement of a crown: include the date the original crown was placed.
- Submissions for replacement of dentures or bridgework: include the date the original appliance was placed, the date that any additional teeth were extracted and the tooth number for any other teeth missing in that arch.
- Submission for a full mouth debridement: use code D4355.
- Submission for periodontal probing: include information on full (four or more) vs. partial (one–three) quadrants.
- Submission for a bone graft when a tooth is present: use code D4263.
- Submission for a bone graft when the tooth is not present : use code D7953.
- Submission for using a laser should be procedure based rather than instrument based. Report the appropriate code based on the actual procedure that was performed.
- Submission for root canal obstruction: use code D3331, “calcification of 50 percent or more of the length of the tooth root.”
- Submission for surgical procedure for isolation of tooth with rubber dam: use code 3910.
- Submission for extractions should include an assessment of the tissue covering the tooth.
- Submission for a crown should include classification of materials
- Crowns made of high noble metal (<60% w/at least 40% Au) should be coded D2750 /D2790
- Crowns made of noble metal (<25%) should be coded D2752 /D2792
- Crowns made of predominantly base (<25%) should be coded D2751/2791
- Crowns made of porcelain/ceramic should be coded D2740