Procedure Playbooks
Step-by-step billing workflows for medical claims in Coral. Each guide covers prior authorization requirements, documentation, claim building, and follow-up — with placeholder spots to add Coral-specific screenshots.
| Procedure | Prior Auth | LMN | Referral/Rx |
|---|---|---|---|
| Emergency & Trauma | No (within 72 hrs) | Required for follow-up | — |
| TMJ / Orthotic | Yes | Yes | Yes |
| Botox | Yes (dual PA) | Yes | Yes (Rx with unit map) |
| Sleep Apnea | Yes | Yes | Yes (MD order required) |
| Extractions & Odontectomy | Yes (elective) | Yes | — |
| Medical Exams & Imaging | CT only | Referral can sub | Managing MD |
Universal rules that apply to every procedure
- Medical diagnosis always goes first on the claim. K-codes are never first. W/V cause codes go last.
- Always wait for the medical EOB before submitting the dental claim as secondary (see Coordination of Benefits).
- ~70% of "not medically necessary" denials get paid on appeal. A denial means a documentation problem, not a dead claim — see Reading a Denial.
- Keep all call logs, auths, EOBs, and appeals in the chart for 7 years.
Abbreviations & key terms
The shorthand used throughout these guides — LMN, PA, EOB, COB, CPT, ICD-10, and the sleep/TMJ clinical terms (AHI, ROM, MRONJ, and so on) — is defined in the Glossary. For the full list of CPT modifiers and when to use each, see the Modifier Reference.