Task Groups

NDEDIC Task Group calls are open to any interested party that abides by NDEDIC's expected conduct rules and is willing to work together to solve industry problems. To learn more about how to join one of NDEDIC’s Task Groups please email info@ndedic.org.

Work Group 1 Task Groups

Pre-determination of Benefits Task Group
This task group is researching dental provider and payer perspectives for three types of inquiries:

  • Pre-determination of benefits, which includes a clinical review
  • Estimate for a patient's treatment plan (at times called a pre-treatment estimate) without a clinical review
  • Prior authorization for proposed procedures

The scope of the information requested and response received, the transactions being used, and commitment to the payer’s response are being discussed. In most cases, these are done in a batch mode, but payers are considering a migration to a real-time model. The task group’s goal is to develop a best practices guide on how these transactions should be completed.

Surveying Dental Providers Task Group
This task group has coordinated the development of a survey of dental providers to better understand their needs as dental payers are planning future system releases. Included are:

  • Eligibility and benefits
  • Estimate for a patient's treatment plan
  • Pre-determination of benefits
  • Prior authorization
  • Claim submission
  • Claim status inquiries

The survey seeks providers' views when these are completed in batch and real-time.

Frequency Limitations Task Group
This task group is researching how an eligibility and benefit response (271) should be coded to inform a provider that multiple procedures share a frequency limitation, that is only one of the procedures is a covered benefit for a period of time.

For example, Panoramic and full mouth are both radiograph procedures, and typically share a frequency. Example: Patient has a frequency of 3 years on both the panoramic radiograph and the full mouth series. However they can only have one of these procedures done in that time period. The frequency limit of 3 years is shared by both procedures.

Work Group 2 Task Groups

Real-time Claims Task Group
Payers that have developed real-time claims systems are contributing their expertise with a goal of developing a best practices guide on this unique claims submission process.

There are 3 other task groups within WG2 that started after the EDI Summit:

  • Claim Adjustment Reason Codes (CARC)/Remittance Advice Remark Codes (RARC) Task Group
    This task group is reviewing the CARC RARC codes in use today to identify situations where the codes dental payers include in the 835 Remittance files do not adequately inform the dental provider of a claim rejection.
  • Administrative Action Task Group
    This task group is reviewing the ways dental payers inform a provider of a claim being reprocessed and adjustments made to the amount initially paid.
  • Trace/Request Remittances & Payments
    This task group is reviewing how a dental provider acquires a 835 Remittance file that somehow was not received by the practice.

Exploratory Task Groups

Dental Lab Prescriptions Task Group
This task group is researching how dental providers submit prescriptions to a dental lab with a possible development of a dental lab prescription message standard.

CAQH 2015 Index (The ROI of EDI) Task Group
This task group is assisting dental payers to better understand and participate in the CAQH 2015 index study. This study is published annually and documents payer costs of conducting business through traditional manual means (paper, phone calls) versus using EDI. The CAQH study has not had any input from dental payers in the past and the task group will be a source of information and support as dental payers plan their participation in the study.

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