Engagement Overview
A multi-location dental group providing implants, crowns, bridges, and other high-value restorative treatments faced recurring delays between treatment planning and appointment scheduling. Inconsistent predetermination submissions, incomplete documentation, and limited follow-up visibility made it difficult to provide patients with timely insurance benefit information.
AnnexMed established a structured predetermination workflow that brought greater consistency to case preparation, payer follow-up, and treatment coordination. The approach helped the group reduce avoidable administrative delays while retaining clinical control over treatment decisions.
Client
Multi-Location Dental Group
Service
Dental Predetermination Support
Review Period
90 Days
Treatment Plans Were Ready. Financial Clearance Was Not.
The group's clinical teams were able to recommend treatment, but administrative uncertainty often delayed the next step. Patients awaiting benefit estimates or payer responses were less likely to move promptly from consultation to scheduled treatment.
Incomplete Predetermination Requests
Missing radiographs, clinical narratives, and supporting documentation led to payer requests for additional information.
Unstructured Payer Follow-Up
Predetermination requests were tracked differently across locations, creating uncertainty around pending responses and outstanding actions.
Delayed Patient Financial Discussions
Without timely benefit information, treatment coordinators struggled to provide patients with clear estimates and confirm scheduling arrangements.
Moving Predetermination Earlier in the Treatment Coordination Process.
AnnexMed redesigned the administrative workflow so that cases requiring predetermination were identified and prepared closer to the point of treatment planning, rather than entering an inconsistent follow-up process after the consultation.
Reactive Case Management
Documentation collected after submission
Follow-up dependent on individual staff
Limited visibility into pending requests
Patient updates delayed by uncertainty
Structured Predetermination Management
Documentation validated before submission
Defined payer follow-up responsibilities
Centralized pending-case tracking
Timely updates to treatment coordinators
How AnnexMed Improved the Workflow
Rather than adding another administrative layer, AnnexMed established a coordinated process connecting treatment planning, insurance review, and patient scheduling.
Identify Cases Requiring Predetermination
Screen planned high-value procedures against payer requirements and practice policies to determine when predetermination should be requested.
Validate Clinical Documentation
Review required radiographs, treatment narratives, procedure details, and supporting records before submission.
Track Payer Responses
Maintain a centralized record of submitted requests, pending decisions, additional information requests, and follow-up deadlines.
Coordinate Financial Clearance
Communicate payer responses and benefit estimates to treatment coordinators to support patient discussions and scheduling decisions.
The Result
The revised predetermination workflow helped the dental group address documentation gaps earlier, maintain consistent payer follow-up, and prevent pending requests from creating unnecessary scheduling delays.
Treatment coordinators gained clearer visibility into case status, outstanding payer requirements, and available benefit information. This supported more timely patient financial discussions and smoother coordination between treatment planning and appointment scheduling.
The engagement established a more predictable administrative process for high-value dental procedures while preserving clinical decision-making and payer-specific coverage requirements.
Solution Impact
Fewer Treatment Scheduling Delays
Fewer Documentation-Related Resubmissions
On-Time Predetermination Follow-Up Achieved
of Performance Monitoring
Proven RCM expertise. Delivered at scale.
For over 20 years, AnnexMed has delivered RCM solutions nationwide, combining expert billing, coding, and AR support to drive measurable results and growth.
- 20+ years of proven healthcare RCM experience
- 2,000+ professionals supporting billing, coding & AR
- 500+ certified coders across multiple specialties
- 99%+ compliance with HIPAA and security standards
- All 50 states served with consistent, scalable operations
