NPI - National Provider Identifier

This post deserves a repeat since many practitioners are not giving this the attention it needs. Like it or not, it will be here soon.

By May of 2007 (or sooner) if you submit your claims electronically, you will have to obtain a ten digit NPI from the government.

The application can be made over the web and usually takes only short time to process and receive. Or you can download and commplete a paper form and mail it in,

Data you will need when you apply is any tax ID's you use, state license number, home and practice address.

More information can be obtained by going to the ADA website www.ada.org.

You can apply at http://nppes.cms.hhs.gov or by calling 800-465-3203.

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What fees do you use when filing dental insurance claims?

There is a tendency, especially if an office has PMS (practice management software) and participates in various dental insurance plans, to use those fee schedule allowances as the charge when filing a claims.

You might be doing both you and your colleques a disservice.

Why?

A number of dental insurance companies use the charge data from their dental population to determine fees. If you submit lower fees, that could drive down their maximum allowance and give an unrealistic impression of what practitioners are using as their normal fees.

Always submit your regular fees. The insurance company will make the adjustment.

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Visit us at The Huskin Group about our dental insurance and practice management services.

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ADA and Alaska

The American Dental Association (ADA) is currently suing based on their feelings that properly licensed persons are not providing adequete healthcare.

What are your thoughts?

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Visit us at The Huskin Group about our dental insurance and practice management services.

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Correct CDT coding of dental insurance claims

An example that can slow down payment because of improper coding is:

Claims are sometimes submitted for fixed prosthesis retainers (abutments) using single crown codes - 2000 Series - Restorative Category- rather than using the 6000 Series – Prosthodontics-fixed Category.

Besides improper procedure reporting, it can also impact benefit levels.

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Visit us at The Huskin Group about our dental insurance and practice management services.

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Correct CDT coding of dental insurance claims

Every 2 years the American Dental Association makes adjustments to the CDT codes based on recommendations from the Code Revision Committee (representing both ADA and insurance companies) so it’s necessary for your office to stay current. The most up-dated version, CDT-2005, is effective for services provided on or after January 1, 2005 and has been designated by the Federal Government as the national standard for reporting dental services. (Offices submitting claims electronically must use CDT-2005 but some insurance companies will accept prior versions on their paper claims).

Our suggestion is that at least every two years, after the new codes have become effective (CDT-2007 becomes official on January 1, 2007) you and your insurance staff should take a comprehensive course to bring you up to date with any changes.

More details to follow on how to code and code correctly

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Correct CDT coding of dental insurance claims

Current Dental Terminology, or better known as the CDT, is recognized by most dental insurance companies and other third party carriers. Many of these companies use the CDT code set as one of their criteria to determine which procedures are referred to a dental consultant for review.

In fact, this field will often be used more often by payers than “Description of Procedure” field for identifying a procedure for benefits.

More details to follow on how to code and code correctly

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Dealing with Dental Insurance Consultants

Know What They Want

Find out what kind of documentation each insurance company actually needs. Why submit information that they won’t even look at?

The trend in some parts of the industry is to request less. It cuts down on cost of internal tracking of this information and return mailings and means there’s less material that can be lost.

Many companies list these requirements on their provider websites. These sites can easily be found by using any of the search engines such as Google, Yahoo, MSN or Altavista

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Dealing with Dental Insurance Consultants

Be familiar with the most recent CDT (Current Dental Terminology) codes and use them properly.

If you’re not coding correctly, you may not be billing and getting reimbursed correctly. Always use the code that most closely describes the procedure which you performed

If you would like to post a subject and start a discussion, EMAIL US BY CLICKING HERE

Visit us at The Huskin Group about our dental insurance and practice management services.

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Dealing with Dental Insurance Consultants

Accuracy and Completeness

If necessity for your treatment is not evident on the x-rays, periodontal charting, or other documentation you submit, always include a narrative. Like the example used to introduce this article, you have examined the patient clinically, the consultant has not and may need that additional information to make a benefit decision.

Stay away from “boiler-plate” narratives. A brief concisely-written narrative describing condition and need will always be considered more appropriate.

If you would like to post a subject and start a discussion, EMAIL US BY CLICKING HERE

Visit us at The Huskin Group about our dental insurance and practice management services.

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Dealing with Dental Insurance Consultants

Accuracy and Completeness

Submit current x-rays. Nothing can be more frustrating for a dental consultant than receiving a claim requesting surgical periodontal services and the x-rays are old and reflect the mouth before these procedures were needed. They're not mind readers.

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Dealing with Dental Insurance Consultants

Accuracy and Completeness

Submit the proper x-rays. It’s easy for the front desk to make a mistake and enclose a film for #3 when you’re filing for a service on #14 but this error can cost you valuable time.

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Dealing with Dental Insurance Consultants

Accuracy and Completeness

If you’re replacing a prosthesis, indicate that fact on the claim in the proper section along with the date of insertion of the previous appliance and the reason for replacement.

A narrative is necessary here if reasons for replacement are not evident on the x-rays: decay, open margin, etc. (Remember that benefits for replacement are not available just because the prosthesis is “old” or “cosmetically unacceptable”. It must have a loss in functionality). If you didn’t originally place the prosthesis, find out its insertion date.

You’ll want to confirm that it’s eligible for replacement based on the frequency terms of the patient’s contract so there are no financial misunderstandings.

If you would like to post a subject and start a discussion, EMAIL US BY CLICKING HERE

Visit us at The Huskin Group about our dental insurance and practice management services.

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Dealing with Dental Insurance Consultants

A common example of inaccuracies or incompleteness that can cause claim delay are:

Not using the correct tooth numbers, dates of service or proper fees. Nothing can be more frustrating to a consultant (and generate delay while an inquiry letter is sent) than a claim where the tooth numbers for the restoration don’t correspond to the need according to the radiographs.

If you would like to post a subject and start a discussion, EMAIL US BY CLICKING HERE

Visit us at The Huskin Group about our dental insurance and practice management services.

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