RESPONDENTS: The seventh annual Survey of Payers was conducted from October 2004 through February 2005, with all potential participants contacted by e-mail and asked to respond to an on-line survey. The response rate totaled 38 out of 158 or 24.04%. This level of participation was similar to all previous years. Aggregating individual respondents’ claims volumes for business year 2003 generated a total of 141,545,686 dental claims in 2003 from all sources. Using two rough estimates of claims potential volume for that year, we estimate respondents represent about 43% – 45% of the marketplace in 2003. Other attributes (company claims volume, scope of operations, and mix of plan types) suggest our sample is representative of the commercial dental benefits industry.

ELECTRONIC CLAIMS: Thirty-seven of the 38 respondents were receiving EDI claims in 2003, and reported a total of 49,743,013 electronic claims – 35.14% EDI claims. While the growth of EDI claims submission over the past 7 years is obvious (from about 1/5th to over 1/3rd), the findings suggest that the adoption of EDI claims submission has not penetrated the dental benefits industry to the extent seen in other parts of our economy. Self-reported percentage of claims auto-adjudicated averaged 61.27%, almost the same as last year’s study. This suggests that those payers accepting electronically are also employing other technology capabilities to enhance their claims processing.

We found that the percentage of payers accepting x-rays electronically had leveled off at roughly 50%, while more than 60% reported that they accept other types of attachments electronically. We also noted that most of the respondents reported that they accept electronic orthodontic claims, pre-treatment estimates and provide online eligibility checks. Lastly, we noted that many of the respondents planned to increase their web-based activities in the year 2004. Presumably our 2005 Survey (soon to be launched) will pick up on this trend.

 

This survey is conducted annually by the National Dental EDI Council (NDEDIC). We request participation of all known commercial dental claims payers. The complete final report is circulated only to members of NDEDIC. We sincerely thank you for your participation and hope you will consider joining the Council as well as becoming more involved in the dental benefits processing community.