Connect dental care to the medical plan when it matters.
Dental practices and dental schools can improve referral completion, patient follow-through, records exchange, and payer operations. The payment route depends on the actual dental service and coverage—not on calling it a care program.
START WITH THE PRACTICE QUESTION
Where can a dental practice work with PrimeVital?
Start with a concrete gap: a medical clearance referral, a missed treatment step, a rejected claim, or disconnected dental and medical records. Each has a different owner and payer.
Medical–dental care coordination
Coordinate oral evaluation and treatment with transplant, cardiac-valve, cancer, or dialysis teams when the medical procedure depends on it.
Payment route
Original Medicare may cover narrowly defined dental services integral to a covered medical service when its documentation and claim rules are met.
Important boundary
Routine cleanings, fillings, and general dental care do not become Medicare covered merely because the patient has a medical condition.
Dental plan operations
Map referral authorizations, CDT documentation, claim edits, denials, follow-up, and patient estimates across dental plans.
Payment route
Use the exact commercial dental, Medicare Advantage supplemental dental, or state Medicaid dental benefit and provider contract.
Important boundary
A CDT code identifies a service; it does not prove the plan covers or pays it. PrimeVital would scope dental-specific RCM expertise before promising claims management.
Technology and records
Connect intake, dental records, medical clearance, scheduling, and referral status where teams currently work in separate portals.
Payment route
Technology and operational work is usually paid under a service agreement; any clinical claim follows the responsible provider and payer.
Important boundary
Do not assume a dental portal, teledentistry interaction, or patient reminder creates a separate Medicare RPM/CCM claim.
PATIENT → PRACTICE → PAYMENT
One accountable clinical owner, with the handoffs made visible.
PrimeVital can design the cross-organization workflow, coordinate agreed follow-up, and build integrations. Clinical decisions and payer submission stay with qualified professionals and the contracted organization.
01
Medical team requests oral clearance
Treating medical professional
Specify the covered medical treatment, clinical timing, and what dental evaluation is needed.
02
Dental team assesses and treats
Dental professional
Document findings, medically necessary work, and its connection to the planned medical service.
03
PrimeVital closes the handoff
Agreed operations team
Track referral status, missing records, patient contact preferences, and exceptions across systems.
04
Clinicians confirm readiness
Medical and dental professionals
Exchange the outcome and decide whether the medical plan can proceed.
05
Billing team validates the route
Eligible billing organization
Check coverage, enrollment, documentation, codes, modifier, authorization, and actual payer response.
BEFORE YOU PROJECT REVENUE
Verify the actual patient, service, professional, and contract.
Is this routine dental care, a plan-specific dental benefit, or a service integral to an identified Medicare-covered medical treatment?
Who is the dental and medical clinician, and is their coordination documented?
For an Original Medicare integral dental claim, verify current KX-modifier, code, setting, and contractor requirements.
For MA, Medi-Cal Dental, or commercial dental, verify the exact plan, provider contract, network, authorization, and patient responsibility.
For a dental school or institute, define student supervision, professional billing entity, records access, and who owns referral follow-through.
PrimeVital supports agreed operations and coordination. The eligible practice or professional remains responsible for clinical decisions, coverage determination, documentation, and claims. No payment or outcome is guaranteed.
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