NDEDIC Releases Dental Industry Guidance on Orthodontic Claims Remittance and Payments

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Reference Guide for Dental Providers and Payers Targets the Difficulties in Reconciling Payments Using a Single Orthodontic Claim Model. Guide Simplifies and Supports Consistent, Standardized Processing of Claims Using ASC X12/005010X221A1 Health Care Claim Payment/Advice (835) .

NDEDIC (National Dental EDI Council) is an affiliate of NCPDP

NDEDIC, the National Dental EDI Council, an affiliate of NCPDP, announced today the availability of a new industry guidance document, the NDEDIC Dental Reference Guide to the ASC X12N/005010X221A1 Health Care Claim Payment/Advice (835) For Orthodontic Claims, Version 1.2. The guide addresses the difficulties that dental providers are having in reconciling payments of a single orthodontic claim model, submitting complete procedure information for orthodontic treatment services that will be delivered over time.

In the single orthodontic claim model, dental payers make an initial payment for a portion of the total reimbursable charges and generate payments to the dental provider over a pre-determined period. Payers generally determine the total amount that is reimbursable for the orthodontic services; financial responsibilities of the payer and patient; and the total number of payments and period of time over which payments will be made. NDEDIC’s guide focuses on the electronic remittance advice (ERA) reporting established by the plan payer for payments to the provider.

The NDEDIC guide represents a collaboration of dental industry stakeholders (e.g., providers, payers, clearinghouses and vendors) in developing best practice recommendations for submission and payment of a single orthodontic claim.

The NDEDIC Dental Reference Guide to the ASC X12/005010X221A1 Health Care Claim Payment/Advice (835), Version 1.2 is available at no cost to its members, and is also available for purchase by non-members at http://ndedic.org/Standards-Information/Work-Group-2-Remittance.aspx. For information on member benefits or to become a member of NDEDIC, visit http://ndedic.org/Membership/Member-Benefits.aspx.

NDEDIC, an affiliate of NCPDP (National Council for Prescription Drug Programs), is a not-for-profit organization focused on promoting the value and increasing utilization of electronic commerce in the dental industry. Through the collaboration of its members, NDEDIC works to standardize data sets and implementation guidelines that will maximize the value of the transactions for dental. NDEDIC’s members include payers, providers, vendors and clearinghouses. For more information, visit http://ndedic.org/.


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