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; typically a peri-apical for anterior teeth
- 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.
Click to view the DAI INDEXV5.pdf
Email: ortho@denis.co.za
Fax: 0866 770 336
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
Fax: 0866 770 336
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:
- Please note that 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 impactable teeth are required
Note:
- Please note that 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
Reference the DENIS Denture Pre-auth List to determine which options require authorisation for dentures.
The following are required for plastic and partial metal frame denture pre-authorisations:
- For partial dentures, the missing tooth numbers
- For full dentures, an indication of the applicable jaw
Complete the applicable pre-authorisation form (Medshield or DENIS):
Send the completed form to customercare@denis.co.za
- Email: customercare@denis.co.za
- Fax: 0866 770 336
- Post: Private Bag X1, Century City, 7446