Processing dental claims electronically.

Abstract

A reduction of healthcare costs is an important part of the reform our society is demanding. We cannot ignore this. Lowering administrative costs is a particularly good way to reduce health care expenditures since this decreases the cost without compromising the quality of services. Implementing an EDI structure for submitting claims and receiving claim remittance advice is one way to significantly reduce the cost of health care by lowering administrative costs. EDI allows the consumer to receive the same level of health care at a lower cost. To accomplish this goal, the industry must accept some standardization. While providers, dental software vendors, and clearinghouses request an electronic claims system that is uniform-payers (insurance companies, State-administered Medicaid programs, etc.) often insist on proprietary formats that fit their own requirements. This impedes the implementation of a successful electronic interchange of data. Under the leadership of the Canadian Dental Association, payers and dentists in Canada were able to create a superior electronic claim processing network, CDAnet. Providers and payers using CDAnet agree that the system works very well. The Canadian dentist does not pay for this service, and insurance companies benefit significantly. Dentists in the USA do not have a universal electronic claim processing network. A USA dentist who wants to send claims electronically has limited selections and often pays additional fees. Organized dentistry has the best opportunity of establishing electronic data interchange between providers and payers in the USA. The first step is creating a universal electronic claim processing system. This system must protect confidentiality by maintaining data that keeps anonymous provider and patient data. It is the dentist who produces the claim. Dentists must become involved in the decisions affecting electronic claim processing. The proper guidance from organized dentistry will enable providers, payers, software vendors, and clearinghouses to cooperate together in creating a cost effective electronic communication network.