Dental Claims Adjudication Features

The Express Scripts Canada dental-adjudication system tracks procedures at the appropriate level (e.g., arch, sextant, quadrant, tooth, surface, or dentition) – depending on the procedure. The system keeps track of all extracted teeth processed on the system, and values incoming claims against the member’s history.

Available features include:

• Accommodates electronic data interchange (EDI) submissions from registered providers using CDAnet versions 2.4 or 4.03. Other networks include CDHA-ADHCnet for denturists and hygienists
• Customized rules, messages, and frequency limitations
• Ability to support online co-ordination of benefits (COB) with public and private-sector plans
• Cost-plus calculations
• Ability to share common core plans and make exceptions for new plans
• Dental professional database with more than 17,000 dental providers
• Reporting capabilities
• Fee guides from 1987 to present