Win the Prior Auth Game in 2026
Getting Ahead in 2026: Prior Auths, GAP Exceptions & Medical Necessity
New year, new revenue cycle goals—and one of the smartest ways to hit the ground running is by getting ahead of prior authorizations.
That’s the focus of my next Profitable Dentist article: “Getting Ahead: Prior Authorizations, GAP Exceptions & Letters of Medical Necessity.”
Here are the essentials every dental team should know in 2026:
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📑 Prior authorizations aren’t just red tape—they’re payers asking you to prove necessity before they pay. The stronger your documentation, the smoother the approval.
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🌉 GAP exceptions can be game-changers. If there’s no in-network provider nearby, you can request out-of-network coverage at in-network rates—if you know how to ask.
- đź–Š Letters of Medical Necessity are your secret weapon. When tied to strong ICD-10-CM diagnosis codes, they justify the care, protect your practice, and give payers what they need to say yes.
đź’ˇ Action Step for January:
Don’t wait for denials. Build a system now for creating Letters of Medical Necessity and tracking prior auths. The investment in time upfront saves thousands in lost revenue later.
Your claims are only as strong as the story you tell. Let’s make sure your 2026 story is one payers can’t deny.
Book Your Prior Authorizations Strategy Session
Here’s to starting 2026 with fewer denials, faster approvals, and more patients saying yes to the treatment they need. Wishing you a year of growth, clarity, and clean claims.
Warmly,
Leslie
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BONUS ALERT!
Free Template: Letter of Medical Necessity
