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Thursday, 02 May 2013 12:41

ADA 2012 paper claim form connects the patient’s oral and systemic health conditions Featured

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medical and dental claimsWith the movement of every industry to move to an eco-friendly environment and reduce our use of paper, it is surprising the need to produce another paper form to add to the problem that we are working to resolve.  Regardless, the need is still present to submit dental claims on paper

And on these essential paper claims, there is the avenue to provide information that proved difficult for dental practitioners to convey to the payers that provides benefits for patients.

The dental community has been educated and practicing the method of billing medical insurance for applicable procedures. 

As the medical and dental industries become more coordinated in the care of patients, so does the reporting of conditions that impact both medical and dental claims and the decisions made by payers to provide benefits

The connectivity of the oral and systemic health conditions is being addressed by both medical and dental professionals.  Now the time has come for the information to be reported to dental benefit payers by use of the ADA 2012 paper claim form.  

There are some new fields in the ADA 2012 claim form that will need some attention by dental practices

First is the reporting of diagnosis codes using the ICD-9 or ICD-10 list. 

Second is a field to indicate “Other Coverage”; this is applicable to either dental or medical coverage

Lastly, there are a variety of other changes such as place of treatment, number of enclosures and other fees. 

All of the information deserves learning how to utilize the new fields and is available on the ADA website.

Regardless of the movement by the ADA to make available the ability to report this important information to payers, we have discovered that the insurers are accepting the new claim form at their own pace. 

Many of our clients are receiving surveys from payers inquiring as to when they will be ready to start submitting the ADA 2012 claim form

I am happy to say that all of our providers have the ability to switch to using the ADA 2012 form. 

I wish I could tell you that the acceptance of the ADA 2012 form would apply to all of the payers, but I can’t.  We have found that some payers can accept it while still accepting the ADA 2006 form.  Other payers cannot even accept the ADA 2012 form until they have the new fields entered into their systems for patients. 

This has proved to be rather difficult to administer since each payer will adopt the changes at different times. 

The ADA has confirmed that there isn’t a cutoff date as to when all of the payers have to accept the ADA 2012 claim form and no longer use the ADA 2006 form.  It will be up to each payer to determine the date they won’t accept the ADA 2006 form any longer.

So what is the solution? 

Well, if you are a DAISY user, just let us know when a majority of payers have indicated that they are accepting the ADA 2012 form and we will assist you in replacing the old form with the new. 

When you update to DAISY 4.3 you will automatically receive the new claim form. 

Regardless of which practice management software you are using, submitting your claims electronically with electronic attachments is always a right click.

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