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Dental Benefits

Auto-adjudication can expedite claims processing, but it can also confuse dentists

Today, many dental benefit plans use auto-adjudication to process a high number of their claims. While auto-adjudication can speed up claim processing, if an office is not aware that this type of technology is being used, the office can be confused and frustrated by processing errors as the result of manual claims submission. The following three examples illustrate how a plan might use auto-adjudication and how that process might affect dental reimbursement.

Billing medical plans for dental treatment

There is an ongoing trend within health care toward integration and consolidation of health care delivery systems. This trend is reflected in provisions of the federal Affordable Care Act, such as the envisioned coordination of care provided under a single entity, the "Accountable Care Organization." The objective of such integration and consolidation is to provide better management of care, create greater efficiencies in the provision of care and improve patient outcomes.

CDA member-dentists: Join our efforts to hold dental benefit plans accountable and improve dental plan coverage

CDA member-dentists can use their voice in two important ways to support dental plan reform and CDA’s advocacy efforts this year: (1) Tell your legislator to support two CDA-sponsored bills that address loopholes in dental plan standards and regulations; and (2) Tell us how your patients’ coverage is disrupting care.
 

CDA supports proposed federal rule to expand Medicare coverage of dental services tied to medically necessary conditions

A proposed rule from the Center for Medicare & Medicaid Services would cover medically necessary dental services as part of the existing medical services benefit in Medicare. CDA last week submitted specific recommendations on coverage of services.
 

Congress is pursuing a Medicare dental benefit: Here's what to know

A significant amount of activity is underway in the U.S. Congress focused on adding dental, vision and hearing benefits to the Medicare program, and the proposals are moving quickly. This communication from CDA supplements what the ADA, media and other sources have shared to give members background and context for the current activity and clarify some common misunderstandings.

Congressional spending deal nears: Medicare dental benefit unlikely to be included

The U.S. Congress is working to finalize the details of President Joe Biden’s Build Back Better Act, and the framework of a final deal is near. While the details of the negotiated agreement have not been made public or acted on by Congress, it appears unlikely that a Medicare dental benefit will be included in the final legislation. 

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