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Patient and Insurance billing system with e-claim functionality E-claims: go through a clearinghouse to submit all e-claims or submit directly to carries that support the X12 files/claims. The X12 EDI Format is the standard defined by ASC (ex-ANSI) and specified by HIPAA. Track referrals and lab cases.
In addition, payment to dental professionals is based on the CDT code(s) reported on the ADA Claim Form, so using the most current codes helps to maximize reimbursement and minimize audit liability. [6] In the near future, dental professionals will be required to use diagnosis codes in support of the procedures and services they provide.
With indemnity dental plans, the insurance company generally pays the dentist a percentage of the cost of services. Restrictions may include the co-payment requirements, waiting period, stated deductible, annual limitations, graduated percentage scales based on the type of procedure, and the length of time that the policy has been owned.
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A medical biller then takes the coded information, combined with the patient's insurance details, and forms a claim that is submitted to the payors. [2] Payors evaluate claims by verifying the patient's insurance details, medical necessity of the recommended medical management plan, and adherence to insurance policy guidelines. [4]
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Dental service organizations, known in the industry as dental support organizations [1] or abbreviated to DSOs, are independent business support centers that contract with dental practices in the United States. They provide business management and support to dental practices, including non-clinical operations. [2] [3]
The Canadian Dental Care Plan is a dental insurance program funded by the Government of Canada to provide dentistry services to uninsured Canadians that meet certain criteria. [1] It replaces a temporary dental benefit program established in 2022 for children under 12 who did not have dental insurance coverage, which was terminated in June 2024.