ARE YOU FILING DENTAL AND OTHER HEALTH CARE INSURANCE CLAIMS ELECTRONICALLY OR ARE YOU PLANNING TO IN THE FUTURE?
On Aug. 17, the U.S. Department of Health and Human Services published the first national standards for electronically reporting dental and other health care procedures. They require that all electronic payment claims follow a single standardized format. As there is a 26-month implementation period, the standards become effective Oct. 16, 2002.
In addition to processing claims, the regulations require payers to accept and process, without delay, all electronic transactions using the version of procedure codes valid when the service was performed (for example, CDT-3 after Jan. 1, 2000). These transactions include eligibility requests and responses, claims payments and remittance advice, claims status request and response, and others that generally are not used by ADA members.
When asked if they file claims electronically, 51 percent of respondents to JADA’s September Question of the Month said they do. "It is the only way to file claims," said one, citing how much time can be saved.
Others say they do but still have to contend with lost claims and long waiting times. "Some insurance companies claim that they never received the e-claim, and we have to resubmit it multiple times," said a respondent.
"Their promise of more prompt payment was kept for six to 12 months," said another. "We now are back to waiting a month just as for paper claims."
A few said they would like to submit e-claims all the time, but not all insurance companies are accepting them yet. "I wish all insurance companies would accept electronic claims," said one. "I occasionally get checks from insurance companies seven days after day of service, when I file e-claims."
Twenty-four percent of respondents said that they are planning to file e-claims. "Obviously, this is the future," said one.
While a few are planning to do so "if necessary," they said they are concerned about the costs. "I plan to, but the use of a clearinghouse or broker is a major block to starting use," said a respondent. "The costs of the software and hardware are nothing to take lightly either."
Twenty-four percent said they are not interested in filing e-claims.
A few said they filed e-claims in the past, but were not satisfied with the results. "I tried e-claims twice; the claims were lost and it took forever," said one respondent. "It is, in my opinion, not yet ready for prime time."
Others said they are satisfied filing insurance claims the old-fashioned way: by paper and phone.
ADA members who would like to start filing e-claims but do not have practice management software, or PMS, in place should call Lauren Fahrer, director of operations, ADA Electronic Commerce, to ask about the ADA’s Electronic Commerce’s options. She can be reached by phone using the members-only toll-free number on the back of ADA membership cards and asking for Ext. 2611 or by e-mail at "fahrerl{at}ada.org". Members also can go to "www.ada.org/prof/prac/manage/software.html" or "www.ada.org/prof/shopping/ecco/ecco.html" for more information about PMS or for companies that offer only e-claims processing, at less cost than PMS.
Members with practice management software in place should contact their vendors about how to get started.
