As of July 1, the Centers for Medicare & Medicaid Services can now accept, process and pay dental claims electronically.
As of July 1, the Centers for Medicare & Medicaid Services can now accept, process and pay dental claims electronically.
In November 2023, CMS issued the 2024 Medicare Physician Fee Schedule final rule, which provided regulatory clarification regarding Medicare coverage for dental services that are inextricably linked to the success of other covered services, such as treatment of head and neck cancers.
CMS previously adopted the ADA Paper Claim Form for submitting dental claims while developing the new system to process the claims electronically as part of its multi-year Medicare Payment System Modernization project. The electronic Health Care Claim: Dental (837D), a Health Insurance Portability and Accountability Act-mandated standard, is used to submit health care claim billing information, encounter information or both from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses. CMS is looking for dental providers to participate in a controlled launch of the system by submitting their claims electronically.
“We appreciate the Centers for Medicare & Medicaid Services’ efforts to implement electronic transactions for dental claims,” said Stacey Gardner, DMD, chair of the ADA Council on Dental Benefit Programs. “The HIPAA-mandated dental claim transaction has been widely adopted by dental providers and is an example of the importance of developing and implementing standards that meet the specific business needs of the dental delivery system. We hope that CMS will continue to consider opportunities to reduce administrative and operational burden for dental providers who have enrolled to provide outpatient dental services in Medicare.”
The Council for Affordable Quality Healthcare’s 2023 annual index — the only industry benchmarking tool that tracks and reports progress on the adoption of electronic administrative transactions — found dental providers could save $1.5 billion annually by switching from manual to fully electronic transactions.
Dentists who are providing Medicare beneficiaries with dental services that are linked to covered medical services can work with the Medicare administrative contractor for their state to ensure they are able to submit 837D electronic dental claims.
“For dentists who participate in Medicare, submission of electronic dental claims offers an opportunity to improve daily operations,” said Caroline Zeller, DDS, a member of the ADA Council on Advocacy for Access and Prevention. “The 837D means no paper, stamps or snail mail and will reduce processing times for claims. I hope that providers will take advantage of the opportunity to work with their MACs and CMS and become early adopters of the CMS Dental Claims Processing System.”
The ADA offers resources and information to dentists on treating Medicare patients at ADA.org/medicare.
Additional resources are available from CMS at medicare.gov/coverage/dental-services and cms.gov/medicare/coverage/dental.