"ADA and AADC Working Together To Help Streamline the Claim Adjudication Process"
David Preble, DDS, JD, CAE & Dennis McHugh
CE Credit hours:1.5
In 2017, staff at the American Dental Association handled almost 7,000 phone calls and email queries on the Code, claims submission and dental benefits issues. Calls ranged from requesting assistance in identifying the proper code to submit, to concerns with explanation of benefits language to complaints about claim denials and disallowed procedures. The issues that are of the most concern to dentists and that are most frequently reported to the ADA, including claim submissions that are disallowed, will be discussed with the objective of having an interactive discussion with attendees on how we can help each other avoid these obstacles and get claims adjudicated promptly.
Upon completion, attendees will be able to:
• Understand the rationale for the most frequently reported concerns that ADA member dentists and staff bring to the attention of the American Dental Association
• Understand concerns that dentists have with claim submissions that are disallowed and why the ADA believes that the practice of disallowing claims is inappropriate and unethical
• Understand the rationale for the advice that is provided to member dentists from ADA staff
• Understand and discuss ways in which dental plans and dental offices can work together to help prevent claim submission errors and help get claims paid promptly
DAVE PREBLE, DDS, JD, CAE is Vice President of the Practice Institute for the American Dental Association. He leads an operating agency responsible to grow the value of ADA membership through the delivery of programs, products and services related to the business of operating a dental practice of any size and to promoting the interests of the dental profession in issues related to health care finance, health outcomes and quality, informatics and standards, and public health. Dr. Preble has a diverse background and experience base as he has practiced dentistry for over 20 years in both private and public health settings, holds a law degree, is a Certified Association Executive, is a Kellogg Executive Scholar in Non-Profit Management and is a Fellow of both the American College of Dentists and the American College of Legal Medicine.
DENNIS MCHUGH is the manager of third party payer advocacy for the American Dental Association and works in the Practice Institute’s Center for Dental Benefits, Coding and Quality (CDBCQ). CDBCQ is the ADA agency responsible for promoting resources and information on dental benefit plans to employers and member dentists. In addition, CDBCQ responds to requests and helps resolve problems from member dentists regarding concerns with third party payers and the CDT Code. He has been with the ADA for 17 years and prior to that spent 7 years working for the American Association of Orthodontists.