Procedures & Requirements

Following is a list of suggestions and requirements pertinent to claims processing. Since many of the groups covered under Dental Dental of New Mexico are subject to a six month waiting period or a missing tooth clause on major services, we strongly urge you to request a predetermination whenever major services are planned.

• Indicate whether prosthesis is initial placement or a replacement. If the prosthesis is initial placement, provide extraction dates. If the prosthesis is a replacement, provide the date of prior placement and need for the replacement.



• When a tooth has had endodontic treatment (RCT) the final fill x-ray is required prior to approval of a crown or bridge procedure.



• X-rays should be current and diagnostic. If x-rays are duplicates, label in a way to determine the correct tooth numbers.



• Narratives are not required for all procedures but usually are helpful when conditions are not obvious on radiographs and in the communication of symptoms.



• Intraoral photographs, while not required, are very helpful. Please send existing condition photos, not the final preparation.



• Periapicals (PA's) must be submitted for all periodontal procedures that require x-rays.