Nothing slows down claims processing like insufficient historical information, added paperwork, administrative inefficiencies, and the lack of proper electronic data interchange (EDI) standards to manage transactions efficiently. Thanks to the continued work and expertise of the NADP EDI WorkGroup, the dental benefits industry has one less administrative hurdle when it comes to claims processing.
Serving as your strong, authoritative industry voice, NADP successfully negotiated with the Centers for Medicare and Medicaid to add a new Remittance Advice Remark Code (RARC). The Code, N849: Missing Tooth Clause: Tooth missing prior to the member effective date, provides clarity on Explanations of Benefits (EOBs). Previously other codes were being used that did not properly explain the true situation. The new RARC was effective March 1. N849 may be found here along with the full RARC list:
Why the RARC Was Needed
For years dental benefits plans, dental support organizations (DSOs), and private dental offices have struggled with new patients’ claim submissions lacking history regarding a missing tooth that existed before the patients’ effective date. In addition, the 835 transaction issued unclear reason codes concerning the missing tooth. Thus, plans, DSOs and dentists followed up with phone calls, letters, and emails to find out why services were not covered.
The new RARC will streamline claims processing for plans and providers, saving both time and money.
How NADP Gained CMS Approval on Your Behalf
Over the course of several months, NADP justified its request for the new RARC by providing CMS examples of how adjudication of these claims was delayed because the lack of information and a RARC to address the problem. During these months of discussion with CMS, NADP solidified its reputation as the voice of the dental benefits industry and established an important relationship that will serve the industry on similar matters in the future.
For more information, contact Dental Informatics Manager Brian Flynn.