NDEDIC Simplifies Dental Industry Implementation of Eligibility & Benefit Inquiry & Response (270/271) Transactions with New Guidance Document

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Guidance document garners rapid support from industry stakeholders, committed to implementation of NDEDIC’s best practice guide and eager to implement real-time EDI in dental

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 Top Dental Eligibility and Benefit Questions Response Guide, which details best practices for consistent implementation of ASC X12 Health Care Eligibility Benefit Inquiry and Response (270/271) transactions. The Eligibility & Benefit Inquiry & Response 270/271 transactions are used to electronically send and receive information about the healthcare eligibility and benefits associated with a subscriber or dependent.

Working Towards Standardization and Real-time EDI in Dental Industry
Today, the dental industry uses a mix of traditional and electronic communication to exchange eligibility and benefits information, ranging from using payer customer service centers, accessing information on multiple payer websites, faxing, and using vendors and clearinghouses. Payers have developed their own companion documents to support use of EDI on their websites.

NDEDIC’s new guide was developed to support a consistent, standardized implementation for the 270/271 transactions. It provides clear, unambiguous definitions of the information that should be exchanged in the 270 inquiry and the 271 response. The guide also encourages broader adoption and deeper deployment of the 270/271 transactions.

Benefits for Providers, Payers and Patients
NDEDIC’s Top Dental Eligibility and Benefit Questions Response Guide, which must be used in conjunction with the ASC X12/005010X279A1 Health Care Eligibility Benefit Inquiry and Response (270/271), benefits both dental providers and payers. Providers can save time by automating the process which conforms to existing workflows, reduce billing costs and collections, improve cash flows and expedite reimbursement. Payers can reduce costs, spend less time responding to eligibility and benefits inquiries, and divert resources to providing other customer services for providers and patients.

“On a national level, at our 39 member company locations, Delta Dental is set to streamline handling patient coverage issues by adopting NDEDIC’s Dental Top Eligibility and Benefit Questions Response Guide best practices concepts,” said Kathy Jönzzon, Director HIPAA Product Services and Support for Delta Dental Plans Association. “The move will enhance electronic eligibility and benefits processing by ensuring crucial patient information is available to provider offices in real-time.”

Jönzzon continued, “As call centers are inundated with routine eligibility and benefits inquiries, proving both time consuming and costly to support, adopting the guide will help Delta Dental Member Companies better resolve patient coverage inquiries faster. As a result of the move, Delta Dental patients will be better served and call center volumes can be reduced.”

“The issuance of the NDEDIC Top Dental Eligibility and Benefits Questions Response Guide is what I like to call a triple win,” explained Art Schoen, Managing Director, Insurance Operations, Aspen Dental Management, Inc. “Upon adoption of these best practices, patients will have improved and more complete information concerning their out of pocket expenses; payers will have a better and more cost effective way to communicate plan information; and providers will be able to enhance the patient experience with minimal disruption to their practice and office teams.”

The NDEDIC guide represents a collaboration of dental industry stakeholders (e.g., providers, payers, clearinghouses and vendors) in the development of standardizing patients top eligibility and benefit questions.

“Our goal is to support standardization of real-time dental transactions,” explained Lee Ann Stember, Interim Executive Director of NDEDIC, and President of NCPDP. “This guide will help providers and payers optimize use of the foundational ASC X12 270/271 transactions to improve administrative efficiencies and provide a frictionless experience for providers and patients.”

The NDEDIC Top Dental Eligibility and Benefit Questions Response Guide 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-1-Eligibility-Benefits.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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