Pre-Authorisation Requirements
Note KeyHealth: Pre-Authorisation Requests for Specialised Dentistry require the ICD-10 codes (as condition-specific waiting periods for dentistry might be applicable to the patient)
The following are required for crown and bridge pre-authorisations:
- An x-ray clearly showing the entire clinical crown, the neck and the upper part of the alveolar bone and periapical area of the tooth in question, i.e. a periapical X-ray
- The tooth number in FDI format ( i.e. two-digit numbering)
- The major clinical code to be used: e.g. 8409 (crown – porcelain/ceramic); 8411 (crown – porcelain with metal). If a post is envisaged, please tell us the primary code for the post and/or core.
- A detailed laboratory quote
- In the case of a bridge, information about any further planned treatments is required along with the above information; for example, this could be a short description about what is planned for other missing or damaged teeth.
Note: Further clinical information may be requested to support an authorisation request.
Email: crowns@denis.co.za
Post: Private Bag X1, Century City, 7446
The following are required for implant pre-authorisations:
- A full treatment plan and quote including prosthodontic phase (i.e. all 3 phases)
- X-rays
- Additional motivation
Email: ortho@denis.co.za
Post: Private Bag X1, Century City, 7446
The following are required for orthodontic pre-authorisations:
- A cephalometric analysis
- An orthodontic treatment plan
- A panoramic X-ray
- Pre-treatment photographs showing the bite in occlusion: the front view, left-side view and right-side view
- Pre-treatment photographs showing a full occlusal view of the mandibula and the maxilla
- A cephalometric X-ray
Note:
- Please submit clear copies of documents and radiographs to ensure authorisation requests are processed as fast as possible.
- Further clinical information may be requested to support an authorisation request.
Email: ortho@denis.co.za
Post: Private Bag X1, Century City, 7446
The following are required for periodontic pre-authorisations:
- A full periodontic chart of CPI-scoring
- A full treatment plan
- X-rays
- A detailed maintenance plan for the remainder of the benefit year
Note:
- Please submit clear copies of documents and radiographs to ensure authorisation requests are processed as fast as possible.
- Further clinical information may be requested to support an authorisation request.
Email: perio@denis.co.za
Post: Private Bag X1, Century City, 7446
The following are required for in-hospital pre-authorisations:
- Hospital practice number
- Anaesthetist practice number
- Treating clinician
- Hospital admission date
- Procedure code(s) with ICD-10 code(s) and where relevant the applicable tooth numbers
- If applicable, medical report of special medical conditions
- A medical report to clinically substantiate a medical condition that warrants general anaesthetics
- Clear X-rays of the impacted teeth are required
Note:
- All hospital cases are assessed individually.
- Further clinical information may be requested to support an authorisation request.
Email: hospitalenq@denis.co.za
Post: Private Bag X1, Century City, 7446
The following are required for moderate/deep sedation pre-authorisations:
- Anaesthetist practice number
- Treating clinician
- Proposed treatment date
- Procedure code(s) with ICD-10 code(s) and where relevant the applicable tooth numbers
- If applicable, medical report of special medical conditions
- Clear X-rays of the impacted teeth are required
Note:
- All sedation cases are assessed individually.
- Further clinical information may be requested to support an authorisation request.
Email: hospitalenq@denis.co.za
Post: Private Bag X1, Century City, 7446
The following are required for plastic and partial chrome cobalt frame denture pre-authorisations:
- For partial dentures, the missing tooth numbers
- For full dentures, an indication of the applicable jaw
Tel: 0861 033 647
Email: customercare@denis.co.za
Post: Private Bag X1, Century City, 7446