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Insurance Committee Report

It is an exciting time to be at the helm of the CAO Insurance Committee.  Building on the progress from past Insurance Chair (and current Insurance Committee member) Dr. Mike Wagner, the Committee plans to implement exciting improvements later this year.

The CAO started the process to develop new insurance codes that allow for the digital submission of benefit pre-determination.  Other dental professionals have had this ability for years, but due to the lack of procedure codes for use by specialist orthodontist services, digital submission was not available on behalf of orthodontic patients.  The inability to submit a predetermination electronically can delay the start time  and/or cause confusion over the extent of coverage for some patients.   This new code will allow for electronic predetermination and will give peace of mind to both patients and orthodontists regarding insurance coverage.

Electronic submission of predeterminations requires the help of the orthodontic software vendors.  The Committee has had conversations with most major vendors who plan to create an update for their Canadian customers that would integrate this feature into their practice software.  By entering a few numbers, with the click of a button, the predetermination can be sent with the patient still in the consult chair. For those insurance companies who allow it, a definitive answer on the available coverage could be obtained almost immediately. No additional patient information is being transmitted to the insurance companies than is being sent at present; the objective is to expedite the process.

For this process to run smoothly, all parties (the orthodontic office, the patient’s insurance company and the software vendor) must work in concert.  Insurance companies have to use a certain version of software.  The CAO has been in regular contact with the Canadian Life & Health Insurance Association (CLHIA) to advise them of these coming changes so that insurance companies can be ready.  The software vendors have been put in contact with the correct people at CDAnet (the approved avenue used to submit digital predeterminations in Canada) so that their engineers can continue to obtain approval to incorporate changes into their software.  Currently OrthoNovo and Dolphin look like they will be the first out of the gate, with Ortho2 and OrthoTrac updates coming on board later this year.   

The Insurance Committee will be sending E-Blasts in the near future with instructions on how orthodontic offices can prepare for these upcoming changes.  The Committee has identified select ‘beta testers’ who already use the various software programs to provide feedback before instructions on how to use this feature are disseminated to the membership. 

Please update your vendor representatives.  They are incentivized to initiate these updates when they hear that their “customers want this”. The more people who reach out, the faster the changes will happen.

Stay tuned in the coming months for updates.

Dr. Greg Barnett

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