Despite the ADA Council on Dental Benefits’ efforts, the practice of using automated electronic means for verifying eligibility and benefits, checking claim status or receiving and reconciling payment remains underutilized by many dental providers according to an index, said Dr. Randall Markarian, council chair.
More than 10 years after these transactions were mandated as part of the concert of regulations associated with the Health Insurance Portability and Accountability Act, only 51% of eligibility and benefits transactions conducted by dental plans are completed using the HIPAA standard, as noted in January’s influential 2019 CAQH Index report.
On a more positive note, the latest CAQH Index showed data that dentists and dental plans are making some of the most significant gains in recent memory, with about a 5% increase in adoption of eligibility transactions, Dr. Markarian said.
Another electronic transaction that saw an increase in the 2019 Index is the receipt of electronic remittance advice via the 835 transaction in lieu of the paper Explanation of Benefits. Also, dental plan electronic remittance advice adoption continued to increase for the second year, rising by five percentage points to 22%.
“While all of this amounts to good news for the dental community, there remains a long way to go before dental practices can experience a fully automated system of interacting with the dental benefit plans, especially when it comes to eligibility and benefits,” said Dr. Markarian.
For the past two years, the ADA Council on Dental Benefit Programs has been working with various industry stakeholders to streamline administrative processes to provide relief from increasing paperwork experienced by dental offices that participate with third-party payment programs.
“The ADA is in the business of making business easier for dentists,” said Dr. Markarian.
The upshot of adoption, said Dr. Markarian, is that electronic transactions can increase the bottom line.
“Sticking with the analog way of doing business is costing practices money,” he said. “The 2019 index reported that dentists could stand to save $6.11 per every eligibility inquiry and response transaction used, and another $3.57 for every electronic remittance advice they receive using the 835 transaction instead of a paper-based Explanation of Benefits.”
Brad Smith, senior director of ACH Network Administration & Industry Verticals at Nacha, short for the National Automated Clearing House Association, said too that electronic funds transfers make sense for dentists from a financial standpoint.
To assist dentists, the Centers for Medicare & Medicaid Services has renewed its outreach efforts aimed at educating all covered entities in order to bring everyone into compliance through its Administrative Simplification Enforcement and Testing Tool program. The covered entities that are beholden to the HIPAA requirements include dental benefit plans, clearinghouses and dental providers.
If a dentist is interested in learning more about how the Administrative Simplification Enforcement and Testing Tool program is enabling compliance, or test an actual transaction exchanged between their office and another covered entity, this information is available at ASETT.CMS.gov.
Dentists who would like to file a complaint about possible noncompliance (i.e., incomplete transactions, non-timely processing of transactions or a required transaction not being offered by a covered entity entirely) can learn more and begin the process on the ASETT website.
To assist dentists who may feel trepidation of changing the way they conduct business, council published a primer to help dentists become more familiar with electronic data interchange transactions called “EDI Transactions: What to Know to Make Them Work for Your Dental Practice”.
The ADA has created an online landing page for dental benefits information that can help dentists address and resolve even their most vexing questions. Go to 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 firstname.lastname@example.org.