Ever had a health fund claim rejected?

I have, and I was shocked.

I thought i’d done something wrong. My patient had come in with a toothache, the tooth was diagnosed necrotic with caries. I subsequently removed the decay, restored it temporarily and extirpated to get the patient out of pain. The health fund denied the 572 + 419 claim saying the two item numbers could not be charged together.

Did you know health funds have business rules that can govern our claims? Business rules that they don’t even tell us about? Neither did I.

We chat through this and many other situations with Dr David Curnow, the current ADA item schedule and third party committee chairman. David generously shared his time (on a Sunday!) to help students, graduates and all dentists make some sense of the often confusing task of itemising our treatment.

In the chat we cover:

  • David’s story – how one finds himself as the ADA Schedule Chairman!
  • What the ‘Outcome Principle’ is and how you can use it to determine your itemisation.
  • Specific situations where two item codes can and cannot be used together
  • Common mistakes
  • What to do if the health fund disputes your claim
  • The secretive health fund ‘business rules’
  • How your item codes relate to fee’s (or don’t)

It’s a dense one, but one that is very important and clears up a few common confusions on the ADA Item Schedule. Enjoy!

The Dental Head Start Podcast is for students and new graduates. We interview successful dentists and specialists to uncover the tips, tricks and advice to help you transition from dental school to private practice successfully.

If you like this content then I ask just one thing of you; share this with a friend who will benefit from this and help us help more students and new grads! Thanks.

David is a recent graduate dentist working in private practice in regional NSW, Australia. Read more at www.dentalheadstart.com/meet-david/

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