Imagn Billing Feature Case: Bone Graft, Barrier & Excision of Bone

In this example Imagn Billing case you will see how a dental office in Washington successfully billed for bone-grafting, barrier, bone excision with biopsy, and complex incision repair. Our Imagn Billing team processed this claim on 08/5/2020 to Premera insurance the claim was denied, and our team filed the appeal on 10/19/2020 and it was paid on 10/31/2020.

The 40-year-old male patient presented for an emergency appointment with symptoms of jaw pain.  Radiographs showed radiolucency surrounding tooth 29-30 with moderate mandible atrophy.  Also noted, a .3 cm cyst encompassing 29-31 area.   

Proving Medical Necessity 

As noted in the provider’s SOAP note: 

  • Medical Indication for removal of 29-30:
  • Severe mandible atrophy caused by .3 cm cyst.
  • Medical Indication for BG: Prepare site for future implant placement, maintain healthy bone level to support existing dentition.
  • Medical Indications for Membrane: protect bone graft and allow bone to mature uninterrupted.

Billing Medical Insurance 

The practice collected all required documentation and clinical SOAP notes. After completing the verification of benefits, it was determined that coverage was available after the deductible is satisfied.  Pre-Authorization was required and was completed with approval along with a Gap exception.

Dental Comparison

Without medical insurance contribution, the practice would be writing off approximately 29% and using of the annual $1000.00 maximum.  Medical insurance saved the patient and the practice approximately $1500, whereas dental insurance would be exhausted. The patient also completely satisfied their deductible, so moving forward they will have less out of pocket expenses if a healthcare issue arises.  

1 thought on “Imagn Billing Feature Case: Bone Graft, Barrier & Excision of Bone”

  1. Ms. Owens,

    I’ve contacted you before. I’m a dentist in the San Francisco Bay area and I’ve taken a medical billing course 1 time prior. the staff found the process too daunting, confused by whether deductibles would interfere with billing, and overall, found the original course interesting, but not enough information or casework was given to the point they were ready to start the process.

    I know you have a course in Dec in Orem and that the last time I looked, many of your courses were there.


    Is your online course cover much of what you cover in person?
    Do you have planned courses to be offered in Northern California?
    If not, could I help arrange for a course in Northern California, and how many attendees would be needed and what would the cost structure look like?

    Since my staff has already had a first dip into this subject, they need a refresher for one thing. However, mostly, they would feel more comfortable if there were lots of sample cases where they could work up so they feel more comfortable upon office return, to start the process.

    I would love to talk to you regarding the above.

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Imagn Medical Billing Service

Due to the complex nature of medical insurance billing, most dental offices are not equipped with the knowledge to properly credential national payers, submit successful claims, or handle aging and appeals. Imagn Medical Billing Service performs the proper credentialing and billing for you, which results in fewer denials and time well saved as you rely on expert help.

One-Time Credential Fee

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The key to more successful payments

Our experts complete the process so you can start billing medical insurance. Each dentist billing medical insurance needs to be credentialed.

Pay Per Case

Verification of Benefit

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We get your patient’s insurance information so you can set proper expectations with the patient regarding the specific coverage available and any out of pocket fees. This is the most critical step in all of medical billing.

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All procedures require pre-authorization in order for your practice to get paid. Gaining appropriate authorization can be challenging, let our experts get the job done for you.

Claim Submission

8% of successful claim

You don’t have time to sit on hold. Let us sit on hold and handle the claim submission work for you  We also handle the aging and appeals so you can focus on your practice.

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What most dentist don’t know is that medical billing can increase your case acceptance rate and ensure your patients get the care they need.

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Patients can no longer afford to have dentists ignore the responsibility of providing care for sleep disorders. Two out of every three Americans report poor sleep; the ability to breathe well is the most important factor in determining a person’s sleep quality. 

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