Administrative and clinical denials by a large dental insurance provider
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Brazilian Oral Research |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1806-83242015000100232 |
Resumo: | The objective of this study was to assess the prevalence and the type of claim denials (administrative, clinical or both) made by a large dental insurance plan. This was a cross-sectional, observational study, which retrospectively collected data from the claims and denial reports of a dental insurance company. The sample consisted of the payment claims submitted by network dentists, based on their procedure reports, reviewed in the third trimester of 2012. The denials were classified and grouped into ‘administrative’, ‘clinical’ or ‘both’. The data were tabulated and submitted to uni- and bivariate analyses. The confidence intervals were 95% and the level of significance was set at 5%. The overall frequency of denials was 8.2% of the total number of procedures performed. The frequency of administrative denials was 72.88%, whereas that of technical denials was 25.95% and that of both, 1.17% (p < 0.05). It was concluded that the overall prevalence of denials in the studied sample was low. Administrative denials were the most prevalent. This type of denial could be reduced if all dental insurance providers had unified clinical and administrative protocols, and if dentists submitted all of the required documentation in accordance with these protocols. |
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Administrative and clinical denials by a large dental insurance providerDental AuditSupplemental HealthHealth Services ResearchForensic DentistryThe objective of this study was to assess the prevalence and the type of claim denials (administrative, clinical or both) made by a large dental insurance plan. This was a cross-sectional, observational study, which retrospectively collected data from the claims and denial reports of a dental insurance company. The sample consisted of the payment claims submitted by network dentists, based on their procedure reports, reviewed in the third trimester of 2012. The denials were classified and grouped into ‘administrative’, ‘clinical’ or ‘both’. The data were tabulated and submitted to uni- and bivariate analyses. The confidence intervals were 95% and the level of significance was set at 5%. The overall frequency of denials was 8.2% of the total number of procedures performed. The frequency of administrative denials was 72.88%, whereas that of technical denials was 25.95% and that of both, 1.17% (p < 0.05). It was concluded that the overall prevalence of denials in the studied sample was low. Administrative denials were the most prevalent. This type of denial could be reduced if all dental insurance providers had unified clinical and administrative protocols, and if dentists submitted all of the required documentation in accordance with these protocols.Sociedade Brasileira de Pesquisa Odontológica - SBPqO2015-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1806-83242015000100232Brazilian Oral Research v.29 n.1 2015reponame:Brazilian Oral Researchinstname:Sociedade Brasileira de Pesquisa Odontológica (SBPqO)instacron:SBPQO10.1590/1807-3107BOR-2015.vol29.0041info:eu-repo/semantics/openAccessMIRANDA,Geraldo EliasSIQUEIRA,Marta Cristina PortesFERREIRA,Ricardo Luiz Siqueira MagalhãesDELWING,FábioDARUGE JÚNIOR,Eduardoeng2018-09-17T00:00:00Zoai:scielo:S1806-83242015000100232Revistahttps://www.scielo.br/j/bor/https://old.scielo.br/oai/scielo-oai.phppob@edu.usp.br||bor@sbpqo.org.br1807-31071806-8324opendoar:2018-09-17T00:00Brazilian Oral Research - Sociedade Brasileira de Pesquisa Odontológica (SBPqO)false |
dc.title.none.fl_str_mv |
Administrative and clinical denials by a large dental insurance provider |
title |
Administrative and clinical denials by a large dental insurance provider |
spellingShingle |
Administrative and clinical denials by a large dental insurance provider MIRANDA,Geraldo Elias Dental Audit Supplemental Health Health Services Research Forensic Dentistry |
title_short |
Administrative and clinical denials by a large dental insurance provider |
title_full |
Administrative and clinical denials by a large dental insurance provider |
title_fullStr |
Administrative and clinical denials by a large dental insurance provider |
title_full_unstemmed |
Administrative and clinical denials by a large dental insurance provider |
title_sort |
Administrative and clinical denials by a large dental insurance provider |
author |
MIRANDA,Geraldo Elias |
author_facet |
MIRANDA,Geraldo Elias SIQUEIRA,Marta Cristina Portes FERREIRA,Ricardo Luiz Siqueira Magalhães DELWING,Fábio DARUGE JÚNIOR,Eduardo |
author_role |
author |
author2 |
SIQUEIRA,Marta Cristina Portes FERREIRA,Ricardo Luiz Siqueira Magalhães DELWING,Fábio DARUGE JÚNIOR,Eduardo |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
MIRANDA,Geraldo Elias SIQUEIRA,Marta Cristina Portes FERREIRA,Ricardo Luiz Siqueira Magalhães DELWING,Fábio DARUGE JÚNIOR,Eduardo |
dc.subject.por.fl_str_mv |
Dental Audit Supplemental Health Health Services Research Forensic Dentistry |
topic |
Dental Audit Supplemental Health Health Services Research Forensic Dentistry |
description |
The objective of this study was to assess the prevalence and the type of claim denials (administrative, clinical or both) made by a large dental insurance plan. This was a cross-sectional, observational study, which retrospectively collected data from the claims and denial reports of a dental insurance company. The sample consisted of the payment claims submitted by network dentists, based on their procedure reports, reviewed in the third trimester of 2012. The denials were classified and grouped into ‘administrative’, ‘clinical’ or ‘both’. The data were tabulated and submitted to uni- and bivariate analyses. The confidence intervals were 95% and the level of significance was set at 5%. The overall frequency of denials was 8.2% of the total number of procedures performed. The frequency of administrative denials was 72.88%, whereas that of technical denials was 25.95% and that of both, 1.17% (p < 0.05). It was concluded that the overall prevalence of denials in the studied sample was low. Administrative denials were the most prevalent. This type of denial could be reduced if all dental insurance providers had unified clinical and administrative protocols, and if dentists submitted all of the required documentation in accordance with these protocols. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015-01-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1806-83242015000100232 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1806-83242015000100232 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/1807-3107BOR-2015.vol29.0041 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Pesquisa Odontológica - SBPqO |
publisher.none.fl_str_mv |
Sociedade Brasileira de Pesquisa Odontológica - SBPqO |
dc.source.none.fl_str_mv |
Brazilian Oral Research v.29 n.1 2015 reponame:Brazilian Oral Research instname:Sociedade Brasileira de Pesquisa Odontológica (SBPqO) instacron:SBPQO |
instname_str |
Sociedade Brasileira de Pesquisa Odontológica (SBPqO) |
instacron_str |
SBPQO |
institution |
SBPQO |
reponame_str |
Brazilian Oral Research |
collection |
Brazilian Oral Research |
repository.name.fl_str_mv |
Brazilian Oral Research - Sociedade Brasileira de Pesquisa Odontológica (SBPqO) |
repository.mail.fl_str_mv |
pob@edu.usp.br||bor@sbpqo.org.br |
_version_ |
1750318324213874688 |