Upon completion of this course, participants should be able to do the following:

1. Explain the basics of a dental benefit plan
2. Explain the difference between various types of plans
3. Work with third-party payers
4. Be knowledgeable about dental claims submission (including predetermination and/or preauthorization)
5. Be familiar with dental coding

The course on Handling Dental Claims, Codes, and Processes explains how to deal with the intricacies of benefit plans. There is information about the many aspects of the insurance claim and dental reimbursement process. Instruction on how to handle a claim form and how to monitor the progress of the submitted forms are so valuable. An overview of coding, including dental/medical cross coding, simplifies the process of completing the claim forms and helps to assure that all of the possible savings to the patient and benefits to the dentist are realized. The fairly new, but very necessary, use of the National Provider Identifier (NPI) is explained and readers are given specific guidance on how to begin the process of applying for an NPI.

The reader will become familiar with all of the terminology used because the course includes definitions in the plan information/contract language section. Definitions of terms such as customary fee, usual fee, and reasonable fee help to make forms understandable instead of confusing. The course also includes a glossary of dental terms.

1. Importance of Health Care Benefits 
   
   
2. Help Your Patients Understand their Dental Benefits Plans 
   
   
3. Use a Dental Insurance or Reimbursement Coordinator 
   
   
4. The Insurance Claim /Dental Reimbursement Process
   
   
5. Handling Dental Claim Forms 
   
   
6. Code on Dental Procedures and Nomenclature
   
   
7. Using the CODE and CDT Manual 
   
   
8. Dental/Medical Cross Coding
   
   
9. National Provider Identifier (NPI) 
   
   
10. ADA Dental Claim Form 
    
    
11. Universal Billing Form
    
    
12. Plan Information/Contract Language
    
    
13. Insurance Monitoring and Follow-Up

1. Dychtwald, K.; Erickson, T.; Morison, R.; Workforce Crisis, How to Beat the Coming Shortage of Skills and Talent, Harvard Business School Press, 2006, page 187.
2. 2005 Survey of Dental Practice, Survey Center, American Dental Association, 2005.
3. Fast-Track Training: The Basics for Dental Staff. Chicago: American Dental Association; 2007. 
4. Inge, Ronald, DDS, “The Ins and Outs of Dental Insurance,” Journal of the American Dental Association, Vol 136, No 2, 204-209, 2005.
5. American Dental Association, http://www.ada.org/prof/resources/topics/hipaa/benefits.asp, accessed March 6, 2007.
6. American Dental Association, http://www.ada.org/prof/resources/topics/benefits/letters.asp, accessed March 19, 2007.
7. CDT Companion: Your Guide to Dental Coding, Council on Dental Benefit Programs, American Dental Association, 2007.
8. American Dental Association, http://www.ada.org/prof/resources/topics/npi.asp, accessed March 7, 2007.