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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 ]
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.
Several state dental associations have attempted to introduce legislation to restrict DSOs from competing within their state. [16] [17] Associations claim that the DSO may exert pressure on dentists to do more work than what is needed, [18] despite studies that show DSO-affiliated dentists actually do less work than the average dentist.
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GEHA (Government Employees Health Association) is a self-insured, not-for-profit association providing medical and dental plans to federal employees and retirees and their families through the Federal Employees Health Benefits program and the Federal Employees Dental and Vision Insurance Program (FEDVIP).
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.