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Volume1 Issue5
CDA
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opinion, this is thewrongapproach for carriers to
take.Whileweappreciate thewillingness tomake
exceptions for somedentists,we stronglydisagree
with the fact that carriers assume theycandictate
howadentist runshisor her office.
Wealsohave tomake sure that carriersdon’t lose
sight of the fact that payments that are sent to
dentists as a result of anassignment areactually
payments that areowed toplanmembers. The
cheque isonlybeing sent toadifferent address.
Sendingpayments toplanmembers at no
cost—because they’re seenas customers—while
imposingacost todentists for the same service is
unacceptable.
Howcan individualdentistshelpCDA
resolve this issue?
Wewant dentists to talk to their patients, and
make sure that patientswhoarecoveredby
problematiccarriersunderstand the situation.We
would like tomake sure that dentistsdon’t endup
having to increase fees topatientsbecausecarriers
arechanging their own internal processes. Their
changes createadditional expenses for dental
offices that can impact thecost of dental care.We
want tomake surepatientsunderstandwhere
thosecosts arecoming from,who is responsible
for them, and thatwhen timecomes to renew
groupplans, their employer is awareof the fact
that their planprovider has created these issues,
not dentists.
Whatwould the ideal system look like?
The ideal systemwouldbeconvenient for both
patients anddentists, follow theCDAnetmodel to
ensureall benefit providersdo things ina similar
fashion, andbeas efficient aspossible so that
dentists can focuson theprovisionof care, not the
administrationof benefit plans.
a
This interviewhasbeencondensedandedited.
Previously, predetermination results
wereprovided toplanmembersonly,
whichcan result in treatment delays.
To receivepredetermination results
fromSunLife,make sureyour system
isnow sending requests toSunLife
withCDAnet version4and submit
thepredetermination request
throughEDI asusual:
• For simplepredetermination
requests, youwill receivea
responseon the spot, inmost
cases.
• For requests that arepending,
SunLifewill notifyyoubyemail
whena result is available. The
details canbeviewedby logging
on toSunLifeDirect, awebportal
for dentists.
To takeof advantageof this service,
make sureyouhavechangedyour
software settings toCDAnet version4
(contact your softwarevendor if nec-
essary) and register for SunLifeDirect.
Planmemberswill continue to re-
ceive thepredetermination results.
a
SunLifemakesreal-timepredeterminationresults
available todentists
To register for SunLifeDirect,
call SunLifeat 1-855-301-4786
Dentists cannow receiveSunLifepredetermination results in real timewhen requesting estimates throughEDIusing
CDAnet version4.
To listen to the full interview, visit
