The 2020 House of Delegates put pressure on ADA Council on Dental Benefit Programs to solve dental benefits challenges doctors face.
The ADA Council on Dental Benefit Programs has selected Change Healthcare to find market solutions that will effectively help solve problems dental professionals currently face with eligibility and benefits verification.
According to the ADA, the technology company will investigate the feasibility of implementing a unified system that would provide dental professionals with accurate information regarding a patient’s dental benefits, possibly through an online portal or app.
The collaboration is a response to Res 102H-2020 adopted by the 2020 House of Delegates, and a report is scheduled to be presented to the 2021 House of Delegates.
In a statement to ADA News, Randall Markarian, DMD, chair of the ADA Council on Dental Benefit Programs, said that if there is a unified system for benefit verification, a dental professional will be able to better inform their patients about what the plan will cover and avoid surprise bills for both the practice and the patient. It will also prevent retroactive denials in those instances when the dental plan mistakenly pays for a service that should not have been covered, he added. Markarian said he’s optimistic about Change Healthcare’s potential to help the ADA and its member dental professionals.
In addition to this effort, the ADA’s Standards Committee on Dental Informatics is developing a companion guide to the HIPAA eligibility transaction (X12 271 eligibility response transaction) to support better use of the existing electronic standards to convey eligibility and benefit information between third-party payers and dental practices. According to the ADA, the eligibility/benefit inquiry transaction is used to obtain information about a benefit plan for an enrollee, including information on eligibility and coverage under the health plan. This inquiry can be sent from a healthcare provider to a health plan, or from one health plan to another.
