Electronic data interchange can transform a dentist’s practice
September 26, 2019
Editor’s note: This is the 28th story in the Decoding Dental Benefits series featuring answers and solutions for dentists when it comes to the world of dental benefits and plans. The series is intended to help untangle many of the issues that can potentially befuddle dentists and their teams so that they can focus on patient care.
Administrative functions are absolutely necessary, but often absolutely no fun.
Obtaining complete and accurate eligibility and benefit verifications for patients, coordinating benefits among multiple dental benefit plans, deciphering the varying requirements for attachments on claims submissions; all combined with dealing with claims payments, denials and their impact on accounts receivable are culminating in an administrative nightmare for many dentists and their practices.
As part of its mission to help member dentists navigate third-party issues, the ADA Center for Dental Benefits, Coding and Quality continues to encourage dentists to streamline their business processes.
To help dentists become more familiar with the electronic data interchange transactions that are most useful in the daily business operations for dental practices, the center has developed a new primer called “EDI Transactions: What to Know to Make Them Work for Your Dental Practice."
The primer is focused on narrowing down the vast litany of electronic data interchange transactions to the transaction types that are used most frequently in the dental industry.
Dr. Dave Preble, senior vice president of the ADA Practice Institute, said that electronic data interchange offers a proven and secure way to improve dentists’ bottom line by eliminating the need for dentists to deal with each dental benefit plan’s unique means of conducting business.
“The opportunities that the adoption of electronic data interchange transactions afford dentists is why the ADA has long-supported dental practice administrative simplification,” said Dr. Preble. “Implementing Health Insurance Portability and Accountability Act-standard electronic data interchange transactions for claims submissions, payments and verification of benefits helps dentists effectively manage their practices by eliminating the need to do the same thing differently when exchanging information with different third-party payer systems.”
Dr. Randall Markarian, chair of the ADA Council on Dental Benefit Programs, said that the dental community generally agrees that substantial savings accrue to the professionals that adopt electronic data interchange transactions as the backbone of the business side of their practices. He pointed to the 2018 findings of the CAQH Index, which is produced annually by the Council of Affordable Quality Healthcare.
“The report estimates that full adoption of electronic processes for the transactions could save the dental industry approximately $2.6 billion in direct costs, with most of these savings accruing to provider offices,” Dr. Markarian said.
Different electronic data interchange transactions are explored in the new primer, along with the shorthand descriptors used to reference each. It provides an overview of how the adoption of each of the different transactions can help dental offices streamline each of the workflow areas that have become part-and-parcel of participating with dental benefit plans.
Electronic data interchange transactions covered in the primer include:
• Patient eligibility benefits information (270/271) — Dentists use this transaction set to verify patients’ dental coverage, benefits and patient responsibilities, such as deductibles, coinsurance and copays.
• Dental claim (837D) — This transaction allows dentists to submit every claim to a dental benefit plan in a matter of minutes. No paper, stamps or rework is necessary.
• Health care claim status request and response (276/277) — Dental offices can learn the status of filed claims instantly using a secure electronic look-up tool.
• Electronic claims payment (CCD+) — Enrollment in electronic claims payments enables practices to receive claims reimbursement via electronic funds transfer instead of waiting on paper checks to arrive in the mail.
• Dental payment and remittance advice (835) — Dentists who enroll in this transaction have a line of sight on the payments coming to them and can easily reconcile their books by receiving explanation of benefits electronically.
This new primer joins a growing library of educational resources that the ADA has developed to break down big concepts into step-by-step guides that highlight the relevant information needed by dentists and their staff. Additional transaction resources available to help dentists include the ADA’s Electronic Funds Transfer Implementation Guide and on-demand webinars including EFT Payments: Exploding The Myth and ERA/EFT Implementation: How to for your Practice.
Other members of the dental landscape can help dentists too. Clearinghouses accept all electronic transactions and establish links with all dental benefit plans so that dentists and their staff are not burdened with managing individual connections with every dental benefit plan they work with.
“If you work with a clearinghouse, they can also be an invaluable partner in assisting with reviewing which electronic data interchange transactions will interact with your systems and how to set up those that will best yield efficiencies for your office,” said Dr. Hope Watson, vice chair of the Council on Dental Benefit Programs.
Similarly, because every practice management system communicates with one or more clearinghouses, dentists can discuss clearinghouse issues with the representative of their practice management system.
“If you have a practice management system, I highly recommend contacting your vendor to make sure your system is set up to take full advantage of the electronic data interchange transactions available through the dental benefit plans you are contracted with,” said Dr. Watson. “If you haven’t updated your practice management system’s software in the past several years, or if you haven’t moved to an electronic practice management system yet, this is a good time to consider some of the many and varied options available to dentists and their practices.”
Dr. Preble said that the desired outcome of the work by the Center for Dental Benefits, Coding and Quality is an environment where dentists and their practices can spend less time focused on paperwork and processes and more time on patient care. He continued, “And adoption of electronic data interchange transactions offers dentists the best way to increase efficiencies for their daily operations and administrative processes.”
To learn more about the ADA Center for Dental Benefits, Coding and Quality and its efforts to improve business efficiencies for dentists and their practices, visit the ADA Administrative Efficiencies Summit webpage.
The ADA’s Council on Dental Benefit Programs encourages members and their office managers to communicate to firstname.lastname@example.org about the administrative burdens they face in their offices.
The ADA’s online landing page for dental benefits information that can help dentists address and resolve even their most vexing questions is at 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 email@example.com, or for questions on the code email firstname.lastname@example.org.
Previous installments in the Decoding Dental Benefits series are available at ADA.org/decoding.