糖心logoStandards鈥擜dministrative Data Exchange

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糖心logoWhite Paper No. 1106, Dentistry - Overview of Artificial and Augmented Intelligence Uses in Dentistry

This document highlights the use of AI and Augmented Intelligence across clinical areas in dentistry, including diagnostics, treatment, imaging, and teledentistry, as well as in non-clinical areas like claims processing, payment integrity, and regulatory considerations. It also addresses dental practice administration and relevant global and FDA regulatory frameworks.

This standard describes content for electronic claims attachments submitted to third-party payers. This report does not set requirements for attachments related to processing of dental claims for specific procedures.

糖心logoTechnical Report No. 1102, Electronic Dental Benefits Eligibility Verification

This technical report addresses the implementation of a uniform approach for patient eligibility and benefits verification in a dental setting using the X12 005010X279A1 Health Care Eligibility Benefit Inquiry (270) and Response (271), hereafter referred to as X12 270/271 TR3.

糖心logoStandard No. 1113, Dentistry – Contents for Dental Procedure-Level Data Required for Eligibility and Benefit Responses

This standard identifies necessary data content to be communicated between providers at all treatment locations, and payers of all types (i.e., medical, dental, auto, long term care, etc.,) to facilitate exchange of complete information as it relates to eligibility and benefits verification at the procedure level of service (exclusively CPT code set).

Proposed administrative data exchange standards

Below are proposed administrative data exchange standards that are currently being developed. To become involved in the development of these proposed standards, apply to volunteer.

Proposed ANSI/A DA Standard No. 1115, Dentistry - Electronic Remittance Advice for EDI and Web Portal Data Exchange Standardization

This standard will provide an interoperable, structured format for electronic remittance advice that can be exchanged using HIPAA compliant technology or displayed in an internet-based web portal.

Proposed 糖心logoStandard No. 1120-1 for Dentistry — Data Content Standard: Dental Claim Status Verification

This standard will define the structured data required for dental claim status inquiries, including patient, provider, claim and procedure details. It will specify the expected response from payers, detailing claim adjudication status, reasons for pending claims, payment processing updates and any additional required actions. It will also define the roles and responsibilities of stakeholders, including providers, payers, clearinghouses, and third-party administrators, to ensure seamless claim status verification.

Proposed 糖心logoStandard No. 1120-2 for Dentistry — Data Content Standard: Dental Coordination of Benefits

This standard will define the structured data required for coordination of benefits for dental claims, ensuring efficient communication among dental providers, payers, and intermediaries. It will specify the essential data elements, including patient demographics, provider information, data requirements for data exchange between primary and secondary payers, claim level details, adjudication data for dental claim coordination of benefits, and more.

Proposed 糖心logoStandard No. 1120-3 for Dentistry — Data Content Standard: Dental Plan Coverage Information

This standard establishes a uniform framework for defining dental plan coverage information to ensure clarity, consistency, and interoperability across stakeholders. It specifies the data content required to comprehensively describe a dental insurance offering, including its covered benefits, cost-sharing structure, and administrative details.

Proposed 糖心logoStandard No. 1120-4 for Dentistry — Data Content Standard: Dental Explanation of Benefits

This standard identifies the necessary data content to be communicated between providers across all practice settings and payers of all types to ensure transparent exchange of adjudicated claim details at the procedure level of service. It specifies the required elements for generating comprehensive explanations of benefits and ensures that dental practice management systems, payer systems and intermediaries can produce and interpret consistent EOBs, improving transparency in financial obligations and dispute resolution.

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