Proposed ADA standard specifies requirements for comprehensive, consistent dental EOBs
Comments due by Aug. 21
A proposed standard to ensure dental explanations of benefits are comprehensive and consistent is available for review and comment from the American Dental Association.
Proposed ANSI/ADA Standard No. 1120-4, Dentistry — Data Content Standard: Dental Explanation of Benefits specifies the required elements for generating a comprehensive dental explanation of benefits. It identifies the data that needs to be communicated between providers across all practice settings and payers of all types to ensure that adjudicated claim details for dental procedures are exchanged transparently.
The document ensures that dental practice management systems, payer systems and intermediaries can produce and interpret consistent explanation of benefits statements, helping to clarify financial obligations and improve dispute resolution. By adopting this standard, the dental industry can reduce administrative follow-ups, enhance revenue cycle predictability and improve provider-patient trust, according to the ADA.
To obtain a copy of the proposed standard for review and comment, visit ADA.org/aipreview. The proposed standards below are also available for review and comment at that webpage. All comments are due by Aug. 21.
• Proposed ANSI/ADA Standard No. 108, Dentistry — Amalgam Separators: This standard specifies requirements and test methods for amalgam separators used in connection with dental equipment. It is a modified adoption of ISO 11143:2008 of the same name and will cancel and replace ANSI/ADA Standard No. 108:2009 and its 2011 addendum. “ISO” refers to the International Organization for Standardization.
• Proposed ANSI/ADA Standard No. 1088, Dentistry — Human Identification by Comparative Dental Analysis: This standard specifies the requirements for identifying an individual by comparative dental analysis.
• Proposed ANSI/ADA Standard No. 1120-5, Dentistry — Data Content Standard — Part 5: Prior Authorization and Predetermination: This standard outlines how to implement a uniform approach for electronic predetermination and prior authorization of dental care services using the X12 278 TR3 prior authorization formats and Health Level Seven International’s Fast Healthcare Interoperability Resources Release 4, or HL7 FHIR R4, DaVinci Prior Authorization Implementation Guide. The document covers the administrative transactions, system interface specifications, provider credentialing data content and core operating rules involved in the pre-dental care delivery administrative workflow between the patient, provider and payer.
The ADA is an American National Standards Institute-Accredited Standards Developer and has been at the forefront of the development of dental standards since 1926. These standards establish requirements for safe and effective dental products and technologies through a consensus-based process.
The ADA working groups that develop these standards include a diverse mix of expert volunteers representing dental practitioners, industry, government and academia. Involvement is open to anyone who would like to contribute their expertise.
To learn more about the ADA Standards Program, visit ADA.org/dentalstandards.
