Predeterminations and Supporting Documentation

Before treatment begins for services such as inlays, onlays, crowns, prosthetics, periodontics and oral surgery, you may file a dental treatment plan with Kansas City Life Insurance Company. We will provide a written response indicating services that will and/or will not be covered per the plan guidelines.

The submitted treatment plan should include the following:

• Procedure(s) using current ADA codes
• Billed Charges
• Dental Necessity
• Applicable supporting X-rays, extraction information, periodontal charting

To file a predetermination electronically go to the website below and register:

• Change Healthcare (formerly Emdeon): 877-363-3666 or visit the website at www.changehealthcare.com
• When registering you will need our payer number, which is CX058

If you prefer to file the predetermination via mail, please send to:

• Kansas City Life Insurance Company
  P.O. Box 9040
  Austin, TX 78766