writerolz.blogg.se - Dental claim sun life insurance canada

D4240 - Crown lengthening is subject to possible fraud anytime gingiva may be "trimmed" to better facilitate impression, or when margin of crown is established deeper subgingivally (deeper beneath the "gumline").

Forms of fraud - Upcoding and misrepresentation of services rendered.

This also erodes more of patient's maximum benefit and increases out of pocket costs.

Potential for fraud - Filing as D2750 porcelain fused to high noble metal ("gold alloy") in order to increase claim reimbursement amounts.

D2751 - Crown, porcelain fused to base metal.

Forms of fraud - Misrepresentation of services rendered.

Potential for fraud - Filing each sealant as D2391 single surface posterior resin.

Potential for fraud - Filing for reimbursement for D0120 when only a few intraoral films were taken.

Forms of fraud - Upcoding and filing for procedures not performed.

Potential for fraud - If the dentist actually performs a regular exam (D0120), but files for the comprehensive periodontal evaluation a more extensive exam that should involve periodontal probing and charting of each tooth, evaluation of the patient's oral and medical history as related to treatment of oral problems and oral cancer evaluation.

D0180 - Comprehensive periodontal evaluation.

Forms of fraud - Upcoding and misrepresentation of services rendered.

Potential for fraud - If the dentist actually performs a dental prophylaxis (prophy), but files the claim for 4 quadrants of scaling and root planing.

D4341/4342 - Periodontal scaling and root planing.Some examples of specific dental codes that may involve acts of fraud: What do I do if I suspect or become aware of an example of dental fraud or abuse?.What are we doing about dental fraud and abuse?.What can stop or reduce dental fraud and abuse?.Some examples of specific dental codes that may involve acts of fraud:.What does an act of dental fraud look like?.With your help, we can all benefit from prevention of fraud and abuse. Please email us at If you have any questions about our fraud and abuse program or about submitting claims correctly, please feel free to call us at 80. We have an electronic mailbox to which either grievances or matters of suspected dental fraud and abuse can be forwarded. Dental plans benefit from having an active fraud and abuse program associated with them. Preventing fraudulent activities can help lower costs, form a better dental network and create higher overall satisfaction for providers, their patients and employers. Prevention and detection of fraud and abuse is in everyone's best interest.