Over time, fees reported to the plan on claim forms are used to monitor trends and serve as the basis for the payer setting allowable amounts for the area. These analysis will not reflect the true market trends if the dentists in that area aren’t submitting their full fee. Coordination of benefits is also dependent upon the fee reported on the claim form.
Dentists should always report their full fee for the procedure code on the claim form, regardless of what the benefit amount is. The full fee represents the costs of providing the service and the value of the dentist’s professional judgment in providing the service. As dentists determine their fees for services rendered, the full fee could be any amount, beginning with zero dollars (i.e., $0.00). A $0.00 report on a claim form is a valid entry.
A dental plan administers a “benefit” to the patient and is not intended to cover all charges. If you bill your full fee the patient will receive the maximum benefit from their plan.
CDT Code and claim submission assistance is available from the ADA. Please call 800-621-8099 or send an email to firstname.lastname@example.org. Assistance is also available when there are issues with a third-party payer. Please call the toll free number or send an email to email@example.com