Claims submitted in late December are processing under 2025 benefits, but anything with a date of service on or after 1/1/26 is hitting the new deductible and frequency limits — even if the preauth was approved in November. I’m flagging crowns and SRP because carriers are kicking back when the DOS doesn’t match the predeterm; anyone else seeing re-adjudications or a clean way to warn patients about alternate benefits before we seat?
But , same here — two crowns preauth’d in November got re-adjudicated when the seat landed 1/2/26 — > was approved in November. I’m flagging crowns and SRP because carriers are kicking back when the DOS doesn’t — Agree on the timing; we started updating the predeterm with the new DOS in the payer portal before filing the claim and adding a short narrative with the predeterm #, and Delta/Guardian honored it without a new preauth. MetLife still made us redo the preauth for SRP, but attaching fresh perio charting cut the back-and-forth.
We’ve been adding a note to the claim requesting a ‘work-in-progress override’ with the prep date plus prep-day photos/impressions, and a few payers have honored the November predeterm even when the seat fell 1/2. When they won’t, we resubmit under the new DOS and warn patients about the deductible ahead of time — it’s the airline gate change nobody asked for but you can plan around. Caveat: Delta PPO here still keys off seat date only unless the plan has a written transition policy.
Quick example: we got Aetna to honor a November predeterm on a 1/2/26 seat by sending a “replacement claim” (837D frequency code 7) with the preauth number, prep date, and lab invoice — rep called it a transition-of-care exception. Small caveat: Delta said “seat date governs,” so we’re front-loading seat appointments in December when possible. Apparently when the calendar flips, crowns turn into pumpkins.