ADA Top Claim Submission and Processing Concerns
The ADA Council on Dental Benefit Programs continually receives and addresses various dental claim submission and adjudication questions from member dentists and practice staff. A series of articles published in the ADA News between discussing “Top 10” concerns about dental claims remains relevant today. The articles included perspectives from ADA members, National Association of Dental Plans (NADP) members, and the Council on Dental Benefit Programs (CDPB).
- D4341, D4342 coding for periodontal scaling and root planing (SRP) per quadrant for partial quadrant
- D4910 coding for periodontal maintenance
- D2950 core buildup, including any pins
- Pre-authorizations
- Claims processing delays
- Bundling and downcoding
- Least expensive alternative treatment clause
- Overpayment/refund requests
- Coordination of benefits
- Assignment of benefits to participating dentists only
- Post-utilization review