ADA seeks members for working group on data content standards for administrative transactions
Guidelines ensure uniformity, clarity, interoperability across systems
The American Dental Association’s Standards Program is seeking members for a new working group on data content standardization.
Data content standards are guidelines on data elements to ensure uniformity, clarity and interoperability across systems required for electronic administrative transactions, particularly those mandated under the Health Insurance Portability and Accountability Act and by state and federal agencies. These guidelines enable standardized information exchange among health plans, providers and other entities.
ADA Standards Program Working Group 11.15 on Data Content Standardization to Support Mandated Administrative Transactions will be tasked with maintaining standards related to the data content required for revenue cycle management, administrative efficiency and burden reduction to ensure seamless communication, reduce errors and improve overall efficiency.
The group will work on the following four proposals for data content standards, with other work items to follow:
• Proposed ADA Standard 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 ADA Standard 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 ADA Standard 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 ADA Standard 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.
To learn more and apply for the working group, visit ADA.org/dentalstandards.
