Polmed Pre-Authorisation Requirements

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 and periapical area of the tooth in question, i.e. a periapical X-ray
• 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 provide the primary clinical code for the post and/or core.
• A detailed laboratory quotation
• 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: PolmedCustomerService@denis.co.za

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

Please submit clear copies of documents and radiographs to ensure authorisation requests are processed as fast as possible.

Note: Further clinical information may be requested to support an authorisation request.

Email: PolmedCustomerService@denis.co.za

• The following are required for partial chrome cobalt frame denture pre-authorisations: For partial dentures, the missing tooth numbers.
• For full dentures, an indication of the applicable jaw

Note: Further clinical information may be requested to support an authorisation request.

Email: PolmedCustomerService@denis.co.za

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
• Reason for GA request
• 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:

• All hospital cases are assessed individually.
• Further clinical information may be requested to support an authorisation request.

Email: PolmedHospitalAuthorisations@denis.co.za
Call:     0860 765 633 (Select 2023 Dental for authorisations for service dates 01 January 2023 onwards)