New dentists may have many concerns when it comes to their patients’ dental plans, benefits and thirdparty payers, often because little of their dental school education relates to learning how to navigate these issues.
Among the concerns are preauthorization requirements, delays in processing claims, claim denials, refund requests and the lack of assignment of benefits to nonparticipating dentists.
Staff of the Center for Dental Benefits, Coding and Quality within the ADA Practice Institute continually receive and address a variety of dental claim submission and adjudication questions from member dentists and practice staff. While many times there are unique concerns, there are often similar questions — which the staff is happy to answer.
The staff has come up with a list of the top five concerns of dentists when it comes to dental benefits, based on calls received from dental offices.
What follows is a brief description of the top five concerns, followed by a resource that member dentists can turn to for further help in those areas. Many more resources are located at ADA.org/dentalbenefits, part of the ADA Center for Professional Success.
The top five concerns, in no particular order, are:
• Provider contract issues.
• Claim rejection. “I know that many dental offices do not take the time
to appeal denied claims, and that’s unfortunate,” said Dr. Steve Snyder, chair of the Council on Dental Benefit Programs. “My recommendation is that if you have a claim that you think should be paid, take the time to teach your staff on how to file a proper appeal.”
• The related trio of bundling, downcoding and the least expensive alternative treatment clause.
• Coordination of benefits. “Increasingly, the ADA receives calls from dentists who want to know which plan is primary and want to know why the secondary carrier refused to pay or paid very little,” said Dr. Snyder. “Calls on coordination of benefits are some of the most frequent calls staff at the ADA receive on dental benefits issues.”
• Electronic fund transfers. The switch to electronic reimbursement by some third-party payers has prompted the ADA Practice Institute to study how dentists could make the change in their offices. “The ADA recognizes that electronic funds is on the road to becoming the preferred payment method of the future,” said Dr. Mark Mihalo, chair of the council’s Coding and Transactions Subcommittee.
Staff from the Center for Dental Benefits, Coding and Quality can help new as well as more experienced dentists with their dental benefit-related problems, questions and concerns. The ADA Third-Party Payer Concierge, a service of the center, can be reached at 1-800-621-8099 or at firstname.lastname@example.org.