Mike Adelberg headshotChanging the Paper Claim: A Call for a Balanced Response

By Mike Adelberg, NADP Executive Director

June 26, 2023

For more than a decade, across the healthcare and insurance continuums, leaders have called on providers to switch from paper to electronic claims. The reasons for making this switch are as familiar as they are compelling: electronic claims cost less to submit than paper claims, e-claims can be paid faster than paper claims, and the data from electronic claims is much more easily aggregated and analyzed. This facilitates research and quality measurements projects that are impractical with paper claims.

The use of electronic claims continues to trend upward. According to a recent estimate from CAQH, only 86% of dental claims are electronic (up from 79% in 2018). Despite this progress, dental still significantly trails medical in the switchover to electronic claims. By CAQH’s estimate, only 3% medical claims are paper (vs. 14% of dental claims). This is likely because so many dentists are solo providers who are least likely to make the investment necessary to submit electronic claims. For the foreseeable future, dental plans and solo practitioners will continue to need each other, and paper claims will be a big part of the working relationship between them.

For this reason, changes to the paper claims form—particularly when it puts paper claims on a diverging track from electronic claims—must be taken seriously. Recently, the American Dental Association’s Dental Content Committee (DeCC) proposed adding three fields to the paper claims form. This will be done without equivalent changes being made to the electronic 837 claim maintained by the consensus-driven stakeholder group, X12. The new fields concern:

  • Treating dentist acting as a “locum tenens” to address when claims may be rejected, or reimbursements delayed because the third-party payer does not know who the treating dentist is.
  • Reporting the last scaling and root planing (SRP) date to expedite timely claim adjudication and reimbursement by providing additional information regarding past treatment.
  • Cells for the national identifier assigned to third-party payers (“Payer ID”) to expedite reimbursement by providing specific identifiers for third-party payers when benefits must be coordinated.

The new fields will be added to the paper claims form and will be effective on January 1, 2024.

At first blush, any changes that misalign the paper and electronic claims submission is worrisome. We want the two claims’ processes aligned for sake of administrative simplicity and in order to facilitate future provider conversions from paper to electronic. Having said that, I encourage dental plans to take a balanced view of the coming changes to the paper claims form.

It appears that the added fields will, in fact, improve claims processing. Effective claims processing and payment requires coordination of benefits information and dental plans are assisted by understanding the “floating” status of their network providers. These same additions might be useful to the 837. The misalignment between the paper claim and the 837 may be more a function of X-12’s lengthy deliberative process rather than a disagreement.

For dental plans there will be expenses associated with taking in the new fields; this includes changes to OCR-claims reading systems, tweaks to policies, and retraining staff and providers. But if the new fields improve claims processing, then these expenses should be acceptable.

The full impact of the changes to the paper claim includes pros and some cons. While the instinctive response from the plan community might be negative, there are advantages to collecting and using the data in these new fields. NADP and its members should monitor the implementation of the new form and maintain an open dialog within the plan community and with the DeCC. We should also recognize the good intentions of that body and, if we need to raise concerns, bring them forward with the same good intentions.



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