Resources Admin/Research
NEA FastLook
A resource that provides up-to-date information on which procedures require documentation, broken down by payer.
Documenting Dental History
Obtaining and documenting a thorough dental history is essential to maintaining proper patient records.
Recovery Audit Program
RAC audits are performed to identify the overutilization of services or services that are not medically necessary. While this may seem like a sensible, necessary program, it has great potential to negatively impact state Medicaid programs and their providers.
Update: Non-Covered Benefit Legislation
Non-covered services are specific services not reimbursed under the terms of the dental benefit contract.
Medical Necessity and Orthodontic Treatment
One major concern for a patient when electing to receive orthodontic treatment is whether or not the treatment will be covered by insurance.
Medical Necessity
Different organizations have different definitions of medical necessity and this can impact the payer's definition as it relates to a particular dental procedure.
What Happens in an Audit
There are no "routine" audits or reviews, so why were these practices audited and what should a practice do when audited?
Potential for Fraud: Submitting the Proper Fee
Reporting the correct fee on a dental claim form is key to receiving proper reimbursement and reducing risk.
Gifting for Referrals
Providing a gift in exchange for a referral may not be legal. Furthermore, offering discounts on your services through advertising websites may also be prohibited.
The Types of NPI Numbers
It is important to understand the two types of NPI numbers so that they can be properly reported on the claim form.
COB in A Nutshell
Coordination of benefits occurs when a patient is covered by more than one dental benefit plan.
Identifying Supernumerary Teeth
A supernumerary tooth is an extra tooth beyond the 32 teeth in the permanent dentition or 20 teeth in the primary dentition.
Fee Capping Legislation Map
A non-covered service is a dental treatment or service that is not covered or reimbursed by the patient's dental benefit plan.
Prompt Payment Laws By State
Prompt Payment Laws By State.
Medical Costs Reduced for Diabetics Receiving Periodontal Therapy
New study shows significant reduction in medical cost for diabetic patients with periodontal disease who receive periodontal therapy.
Call Center Information - Be Wary!
Call centers are not always aware of their own revised policies - here is one practice's experience with this frustrating issue
How to Read a Dental Insurance Card
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Dental Practice Act URLs by State
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Caries Risk Assessment Form
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