Third-party claims: It’s now, or possibly never!

No more waiting for the patient to return for the final restoration before filing a third-party claim. There is a solution!

Dental Insurance

Does this sound familiar? Your patient needs a crown, the tooth is prepared, and the impression is sent to the dental lab. During this process, you incur an expense with the lab for the fabrication of the restoration. The patient is placed in a temporary crown, and an appointment is made within a couple of weeks for the final restoration to be placed.

Dental InsuranceWaiting to file a third-party claim for a crown or partial puts a lot of unnecessary pressure on you and your business team to ensure the patient will return for the seat/delivery appointment. You hope your business teamwas able to make solid financial arrangements with the patient because they will not be able to file for reimbursement from the patient’s insurance until the patient comes back to have the crown seated.

There is now a solution to this problem. It is not necessary to wait for the patient to return for the final restoration before filing a third-party claim. According to the ADA Current Policies, “Payment for Prosthodontic Treatment (Trans.1989:547) Resolved, that the Council on Dental Benefit Programs encourages all third-party payers to recognize the preparation date as the date of service, that is, payment date, for fixed prosthodontic treatment, and be it further Resolved, that the Council on Dental Benefit Programs encourages all third-party payers to recognize the final impression date as the date of service, that is, payment date, for removable prosthodontic treatment.”(1)Of course, if you are aware that the third party will pay upon the seat/delivery, you must file on that appropriate date.

I was recently consulting in a multi-doctor practice where the protocol for each provider was different when filing payment claims for crowns and removable prosthesis. One doctor was filing on the prosthesis seat date because “That is how he has always done it.” The other doctor was filing on the prep date for crowns because, “That is how she has always done it.” Our solution to this scenario included adopting the aforementioned ADA policy. These two providers now file claims for prostheses on the preparation date for crowns and the final impression date for removable prostheses.

Consistency with filing of third party claims in a multi-doctor practice is essential for the business team to stay current with collections. It’s difficult to track account receivables when the team has to determine who the provider is and recall that provider’s protocol for filing third-party claims. Now that the office policy is consistent with all providers, there is far less confusion. The providers have less stress because they know they’ll be able to file the third-party claim at the prep or final impression appointment and at least be reimbursed for the lab expenses if the patient fails to return for the delivery appointment. Having written and signed financial agreements coupled with excellent communication between the dental team and patients will help ensure that patients return for their beautiful restorations!

Danya Montoya

Danya Montoya, EDDA, CIS, CDD, Business Advisor for Jameson Management Inc., has over 22 years experience in the dental industry. She is a Clinical Ambassador for E4d Technologies and CAD/CAM dentistry, and a Certified Integration Specialist and Certified Dental Designer with Planmeca University. Her passion for dentistry exudes through her desire to coach teams to achieve their goals in a deeper way where others have only scratched the surface.

1. ADA Current Policies: Payment for Prosthodontic Treatment. (2013, January 1). Retrieved August 30, 2014 from http://www.ada.org/~/media/ADA/Member Center/FIles/2013 Current Policies Final.ashx

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