Medibank & ahm mandate new rules on tooth ID for customer claims
From November 1 this year, the private health insurance fund Medibank Private and its subsidiary ahm will mandate the inclusion of FDI two-digit tooth identification numbers on all invoices.
In a move that the ADA has criticised as unnecessary since The Australian Schedule of Dental Services and Glossary does not require their inclusion, the fund will require the tooth ID numbers be added to all claims in order, it says, "to ensure the consistency and accuracy of the payment of benefits to … patients."
The new requirement was announced via letters sent to dentists in late August and will apply to "all invoicing, receipting and electronic claiming when treating Medibank members."
The implementation of this policy by Medibank turns what had been a practice used by some dentists into an obligatory element whose absence will presumably result in non-payment of the claim or subsequently, be used for auditing dentists and requiring them to repay money which the fund has already paid to patients (though these implications have not been confirmed).
In responding to Medibank’s new requirement, the ADA has pointed out that The Australian Schedule of Dental Services and Glossary, which is the definitive coding system for items and clinical procedures in Australia,, does not insist on tooth identification and in some cases it is difficult to assign a tooth number for some procedures, in effect rendering the fund’s addition to its claiming requirements wholly unnecessary.
Most dental practice software providers, however, do include tooth identification.