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ADA advocates streamlining electronic payment transactions

January 25, 2019

By David Burger

Photo of Dr. Mihalo at efficiencies summit
Summit: Dr. Mark Mihalo, chair of the ADA Council on Dental Benefit Programs' Coding and Transactions Subcommittee, converses in August 2018 at the Administrative Efficiencies Summit at ADA Headquarters. Dr. Craig Ratner, former chair of the Council on Dental Practice, is in the background in the gray jacket.
The Association is acutely aware of the problems dental offices face in adapting to the continued push from third-party payers to gain administrative efficiency on their end by moving away from paper checks to electronic reimbursement.

"The ADA recognizes that electronic funds transfers are on the road to becoming the preferred payment method of the future," said Dr. Mark Mihalo, chair of the ADA Council on Dental Benefit Programs' Coding and Transactions Subcommittee. "However, the industry must recognize its role in assisting dental offices to be able to adapt to this change without inadvertently increasing inefficiencies for dental offices.  The 2018 CAQH Index Report estimates that by moving into electronic payments and remittance advice, third-party payers can save $131 million and dental offices can save $539 million. There is a win-win situation for all sides if the system works well."

CAQH is the Council for Affordable Quality Healthcare, a nonprofit organization. The CAQH Index, according to the group's website, "tracks adoption of HIPAA (Health Insurance Portability and Accountability Act of 1996) mandated and other electronic administrative transactions for conducting routine business between health care providers and health plans in the medical and dental industries."

With that in mind, the ADA, along with several key stakeholders in the dental industry, issued what is called an "open community statement" on Jan. 23. The statement is intended to promote the use of HIPAA-standard electronic transactions for claims payment and electronic remittance in order to promote a system that secures efficiencies both for payers and dental offices.

The statement, addressed to dental benefit plans, clearinghouses, practice management software vendors and financial institutions, is the first notable deliverable to come out of the first-of-its-kind Administrative Efficiencies Summit at ADA Headquarters held in August 2018, Dr. Mihalo noted. At the summit more than 30 representatives from various sectors of the dental community, whose activities and products affect the administrative costs of a dental practice, met with a goal of bringing practical solutions to address administrative burdens.

"We are pleased with the community statement and believe that this is the first step in addressing the increasing administrative burden for dental offices participating with third party payment programs," said Dr. Mihalo.
Photo of Dr. Kessler at efficiencies summit
E-payments: Dr. Brett Kessler, second from right and vice chair of the ADA Council on Dental Benefit Programs, speaks at the August 2018 Administrative Efficiencies Summit at ADA Headquarters.

The Jan. 23 statement, available at ADA.org/dentalbenefits, highlights the following as essential elements in the electronic funds transfer (EFT) and electronic remittance advice (ERA) transactions:

  • For every EFT payment an office receives there must be a corresponding ERA sent to the dental office.
  • The total amount of payment transmitted in the EFT must equal the total amount of payment indicated on an associated ERA.
  • These two pieces of information must be matchable through a unique trace number.
  • One ERA may contain information on multiple claims.
  • Dental offices must receive the ERA within three days of receiving the EFT.
  • The EFT should clearly display the payee information, effective date of the payment, total amount and payment-related information that allows matching with the ERA.
  • The ERA should display total actual provider payment amount, EFT trace number and payer identification.

If ADA members are receiving EFTs or ERAs without the above information, they are encouraged to contact their third-party payer provider relations representative or contact ADA staff for assistance in resolving problems by emailing dentalbenefits@ada.org or calling 1-800-621-8099.

"We are also aware of the key role played by practice management software vendors who have yet to develop automated solutions to reconcile the EFTs and ERAs," said Dr. Mihalo. "Through the summit we are encouraging software vendors to play their part in resolving issues for dental offices," he added.

"Dentists have unknowingly borne the burden of manual administrative costs when there are automated solutions," said Dr. Brett Kessler, vice chair of the Council on Dental Benefit Programs. "Both HIPAA and the Affordable Care Act established nationwide standards for electronic remittance advices and electronic funds transfers. The ADA's efforts through the summit will help all members reduce their overhead through automating manual processes."

The council in 2018 released an electronic funds transfer implementation checklist aimed at helping dentists who decide on their own to move from paper to electronic payments, said Dr. Mihalo. "The checklist reflects lessons learned during our 2017 study of dentists who moved from paper payments to electronic payments," he said. This free-to-download checklist is available at ADA.org/EFTChecklist.

The ADA also has an on-demand webinar on electronic funds transfers — addressing the how, the why and the myths — available at ADA.org/EFTwebinar.

The ADA's online landing page for dental benefits information can help dentists address and resolve even their most vexing questions: ADA.org/dentalbenefits, part of the ADA Center for Professional Success.

Staff from the Center for Dental Benefits, Coding and Quality can help dentists with dental benefits-related and coding problems, questions and concerns. Call the ADA's Third Party Payer Concierge at 1-800-621-8099 or email dentalbenefits@ada.org.