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Dental consultant the star of April webinar on claims processing denials, delays

March 22, 2019

By David Burger

Photo of Dr. Vidone
Dr. Vidone
Photo of Dr. Bulnes
Dr. Bulnes
Photo of Dr. Calitri
Dr. Calitri
Some of the most common concerns reported to the ADA by member dentists are claim denials and requests for additional information. Dentists want to know why the benefit for the treatment plan agreed upon by their patient may be denied or delayed.

Dentists and dental team members who have ever had issues with their claims are invited to a free ADA webinar on April 18 at noon Central time called Claims Submission in the Eyes of a Dental Consultant – Session 1. One hour of continuing education is offered.

Dr. Linda Vidone, an ADA member and vice president of clinical management for Delta Dental of Massachusetts, will discuss claims submission expectations and responsibilities of a dental consultant, as well as why the information and appropriate documentation is necessary in order to adjudicate claim submissions from a payers' perspective.

Two representatives from the ADA Council on Dental Benefit Programs, Drs. Christopher Bulnes and Paul Calitri, will also appear on the webinar to weigh in on those requirements and present ADA views based on best practices and policy adopted by the ADA's House of Delegates. Dr. Bulnes is chair of the Council on Dental Benefit Programs.

Dr. Vidone has over 15 years of dental experience in private practice, dental school faculty and dental benefits and is president of the American Association of Dental Consultants. She received her dental degree and advanced certificates in prosthetics and periodontics at Boston University and still maintains a private practice in periodontics in Brookline, Massachusetts.

In an interview, Dr. Vidone said that the objectives for the webinar are for dentists and their dental teams to:

  • Have a better and more thorough understanding of dental benefits and its complexities.
  • Have a better understanding of current treatment and claims submission strategies in dental offices and expectations related to dental consultant review.
  • Improve knowledge and understanding of proper CDT coding in a dental practice.

"By seeing examples of inappropriate claim submission, participants will understand the importance of submitting specific documentation on a claim form including appropriate CDT codes; radiographs that are legible, diagnostic, currently dated and labeled right/left for expediting the review of their claims; and narratives that are specific to a particular patient, as opposed to generic narratives that mainly repeat the CDT descriptor and/or nomenclature," Dr. Vidone said.

As to what a dentist or dental team member should get out of this webinar, Dr. Vidone said that they should understand why claims do not get paid or get delayed during claims processing. Some of the reasons include the submitter not understanding purchaser contractual guidelines; not understanding the dental carrier guidelines; missing information or inaccurate information on the claim form; CDT coding errors; lack of requested documentation; and undiagnostic X-rays.

Register here.

For more information on ADA's activities on third party payer advocacy and dental benefits, visit ADA.org/dentalbenefits.