Prior authorization and dental predeterminations
Dental predeterminations are built: Eligibility Hub sends them electronically as dental claims flagged for predetermination and matches returned estimates to the treatment plan. Medical prior authorization is partly built: requirements are flagged from eligibility and payer rules, and each request is tracked. Until electronic 278 submission is available, we prepare medical requests and submit them through payer portals.
At a glance
- Availability
- Partially availableDental predeterminations are built. Medical electronic 278 submission is planned; until then medical requests go through payer portals.
- Part of the cycle
- Authorize: coverage checks, prior authorization, predeterminations
- What it costs
- Included in the full service at 1.5% of insurance collections, meaning payments received from payers. Patient payments are not included.
- Your practice
- Provide clinical documentation
Who does what
Eligibility Hub does
- Flag authorization requirements from eligibility and payer rules
- Prepare each request and track its status, reference number, dates and documents
- Send dental predeterminations electronically and match estimates to the treatment plan
- Submit medical requests through payer portals while electronic 278 submission is planned
Your practice does
- Provide clinical documentation
- Sign where a payer requires it
Dental and medical, side by side
Dental (built)
- Predeterminations sent electronically as dental claims flagged for predetermination
- Returned estimates matched to the treatment plan
Medical (partly built)
- Authorization requirements flagged from eligibility and payer rules
- Each request tracked with status, reference number, dates and documents
- Electronic 278 submission through a payer-portal partner is planned
Limits worth knowing
- Electronic 278 submission for medical authorizations is planned, not available.
- An approved authorization or estimate is not a guarantee of payment.
Questions
Can we outsource prior authorization to you?
Yes for preparation and tracking. Dental predeterminations are sent electronically. Medical requests are prepared by us and submitted through payer portals while electronic 278 submission is planned.
What is a dental predetermination?
A pre-treatment estimate. The hub sends it as a dental claim flagged for predetermination and matches the payer's estimate to your treatment plan.
Who signs the request?
Your practice provides clinical documentation and signs where the payer requires it. We prepare the rest and track it.
How do we see request status?
Each request is tracked in the hub with its status, reference number, dates and documents.
Review the scope before you begin
The full service is 1.5% of insurance collections, meaning payments received from payers. Patient payments are not included. See pricing for how the fee is calculated.
Last updated 2026-10-06