What’s new in CDAnet V4 and SunLife Insurance Standards?
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One of the features CDAnet version 4 that is of high value to dental offices is the ability to have within the claim a treating dentist who is different from the billing dentist. It allows dentists to send a payment to the person that is supposed to receive it when they assign claims.
While behaving in CDAnet V4 like offices did in CDAnet V2 is in theory not the right thing to do, dental offices are being forced into doing it by the implementation of the standard provided by SunLife.
CDA has worked with SunLife to ensure that their standard does not create problems for dental offices. There is a need to move away from the requirement to fill out the name of the principal dentist in the treating dentist field. However, as long as the carriers do not allow that to happen, dental offices should be aware of it and will have to tolerate it.
The following questions were asked by a dentist, following the distribution of the post
With V4, is the claim paid to the billing (principal)dentist and the record of treatment assigned to the treating (associate) dentist?
In v4, the “billing” dentist and “billing” office can be identified in addition to the treating dentist and office. Payments for assigned claims are to be paid to the “billing” dentist at the “billing” office. The field cannot be blank, so if the treating and billing are the same dentist, the treating dentist goes in the billing field also. Unfortunately, Sun Life did not implement this in their recent upgrade to v4 – they ignore the “billing” field and always pay the treating dentist.
With V2, with only one dentist name revealed (the principal/billing dentist), are all records such that the billing dentist is thought of as the treating dentist and the billing dentist?
The CDAnet subscription agreements that dentist sign to use the service dictates that the dentist identified in a v2 claim be the treating dentist, and the office be the treating office. Unfortunately, because carriers have not implemented v4, or implemented it properly in the case of Sun Life, some dentists will indicate only the “billing” dentist to facilitate business processes in their offices. This is contrary to the intended functionality. Note that some dentists are now using direct deposit services from the carriers, so that claims properly indicate the treating dentist, and the payment is deposited in the account preferred by the principal dentist.
Do the treating and billing dentists both have to be members of the CDA?
All the dentists need to be subscribed to CDAnet to be on the list that CDA sends to the carriers that authorizes them to transmit claims. To subscribe to CDAnet, the dentist needs to be a member of ODA, and therefore CDA. Once the dentist is a member, she completes this form and faxes it to CDA, and then completes this form to enrol with ITRANS if the office uses ITRANS.
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