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Volume2 Issue5
CDA
at
W
ork
Manydentistswill rememberwhensending
dentalclaimswasatime-consuming,paper-
basedprocess.
Once thepatientwasbilled for treatment, if theyhad
dental insurance, thedental officewould complete
and sign a claim form and thepatientwouldmail the
dental claim form to their insuranceprovider.The
insuranceprovider entered the informationon the
claim form into their computer systems, adjudicated
the claim and—if therewereno errors in the
paperwork andno further clarifications required—
thepatientwaitedup to8weeksbefore receiving a
cheque!
ALOOKBACK
But in1991, an innovation significantly reduced the
timeneeded for reimbursement andchanged theway
dental officesandpatients communicatedwith insurance
companies from that year forward.
The ideawasborn in theplainlynamedCDAcommittee,
theThird-PartyDental PlansCommittee,whichwas
formed in1984 in response tocriticism thatCDAneeded to
improvecommunicationbetweendentistsand insurance
companies. Thechallengewas takenonby thecommittee’s
foundingmembers:Dr. TobyGushue fromNewfoundland,
Dr.DonGutkin fromManitoba,Dr. Bill Leggett from
Ontario, andDr.DonMacFarlane fromBritishColumbia.
Atfirst, thecommittee’smaingoalswere todevelopa
standarddental claim form (at that time different forms
wereusedbyeach insurancecompany) anddevelop
anew system thatwould standardize thewaydental
procedureswerecodedanddefinedacross thecountry.
Eachprovincehad itsown setofprocedurecodes,
whichcreatedacomplicatedand inefficient systemof
administration for thebigger insurancecompanieswith
clients inmore thanoneprovince.
“Theprovincesdidnotwant tochange their systems,” says
Dr.Gushue. “Theywerehappywith theirowndefinitions.”
It took several yearsof closelyworkingwith theprovincial
associationsandvarious specialtygroups, but anational
system for identifying thedental servicesprovided to
patients, theCDA’sUniformSystemofCodesandListof
Services (USC&LS)—now thebasisof all feeguidesand
code lists—was implemented in1990.
Tohear an interview
withDr. TobyGushue
onCDAnet, visit
