Dental Claims Research Articles

Data Warehouses and Evidence-Based Dental Insurance Benefits

Data warehouses can help dental insurance companies perform the crucial work of designing dental benefits programs to implement evidence-based treatment protocols. Through an extensive process to standardize data elementsand create relational databases, dental insurance claims information can be stored in a historical fashion that permits retrospective and prospective analysis for program design. These databases require appropriate scientific and business analysis skills to properly interpret and apply findings from these rich data repositories. Such studies can contribute to ongoing evidence-based research to promote new avenues of investigation and refinement of recommendations. This article discusses the general characteristics of dental claims-based data warehouses, including the potential benefits and limitations. We provide an example of how a data warehouse facilitated the appraisal of implementation of evidence-based treatment guidelines.

Medicolegal claims against anaesthetists: a 20 year study.

A total of 222 medicolegal claims involving 160 anaesthetist members of Victoria's largest medical indemnity organization during the period 1980 to 1999 are reported, with 35% of anaesthetists having a claim. There were 49 claims in the first decade and 173 in the second, with 84 related to dental injury being predominant. Other common causes of claims were awareness, epidural anaesthesia, coronial enquiries, nerve palsies, postoperative complications and circulatory arrest. Anaesthetists were joined with surgeons in 17 claims. The average delay between the incident and the resolution of the claim was 11 months for dental claims and 46 months for non-dental ones.

Do regular dental visits affect the oral health care provided to people with HIV?

Financial factors related to income and insurance coverage have been found to limit access to, and influence use of, oral health care services by people with human immunodeficiency virus, or HIV. The authors determined if visiting a dentist regularly affected the oral health services provided to people with HIV when financial barriers were eliminated as an impediment to access. They analyzed dental claims data for services submitted for payment to the Minnesota Access to Dental Care Program. The analyses focused on comparisons of dental utilization patterns among 273 people classified as regular patients, or RPs, and 222 people classified as nonregular patients, or NRPs. RPs were found to have been provided more diagnostic and preventive care, and less restorative, endodontic, periodontic, removable prosthodontic and oral surgical treatment than were NRPs. Although the mean submitted cost per patient visit was much higher for NRPs, total mean submitted costs per patient for RPs and NRPs were not significantly different. Even though NRPs underwent fewer procedures and had fewer clinic visits than did RPs, the procedures provided to NRPs were more complex and costly. As indicated by differences in the mix of dental care services provided to RPs vs. NRPs, continuity of primary oral health care for RPs led to a better oral health result at no increase in cost over that for NRPs. The study findings provide substantial evidence regarding the value of regular oral health care for people with HIV. This study reinforces the need for dentists to educate and encourage people with HIV to integrate regular oral health care into the ongoing maintenance of their overall health and well-being.

Utilization of dental health services by Danish adolescents attending private or public dental health care systems

The objectives of the study were: 1) to describe the choice of dental care system among 16-year-olds, 2) to describe the utilization of dental services among 16-17-year-olds enrolled in either public or private dental care systems, and to compare the dental services provided by the alternative systems. The study comprised 1,245 adolescents from 3 municipalities; the historical cohort study design was applied; and data were collected from dental records (public dental service) and dental claims (private practice). At age 16, 12% preferred being enrolled in the private practice system, while 88% remained in the public dental care system. During the 2-year study period the attendance rate was 99% for the public system, while 90% attended the private practice system (P < 0.001). Preventive dental services were provided more frequently by the public than the private system (P < 0.001). Despite the fact that the economic barrier was eliminated a lower attendance rate was observed for patients transferred to the private practice system.

Travel insurance claims made by travellers from Australia for dental conditions

Little is known about dental problems suffered by travellers abroad. This study was designed to investigate travel insurance claims made by travellers from Australia for dental conditions, particularly examining demographic factors, type of travel insurance coverage, nature and duration of travel, when dental treatment was sought during travel, use of emergency assistance, type of treatment, and claim outcome, including cost. 1,289 claims submitted during 1998-99 to a major Australian-based travel insurance company were examined for dental claims. 104 (8.1%) claims for dental conditions were submitted, of which 45 (43.3%) were made by male and 59 (56.7%) by female travellers. The majority of claimants were in the 60 years and over age group 54 (52.4%). Dental conditions reported required conservative (mostly fillings) 31 (29.8%), endodontic (mostly root canal treatment) 19 (18.3%), prosthodontic 27 (26.0%), periodontal 8 (7.7%), oral and maxillofacial surgery 2 (1.9%) and other or multiple 17 (16.3%) treatments. Use of the travel insurance emergency telephone service for dental conditions was reported in only seven cases (6.7%). Almost two-thirds 64 (61.5%) of claims were accepted. Claims for prosthodontic treatment were significantly less likely to be accepted. The majority of dental conditions did not require further medical investigations, 74 (71.2%). The mean cost of payouts to claims was AU$238.06 for males and AU$182.58 for females. Claims for endodontic and prosthodontic treatment were significantly more expensive than other types of treatment. Claims for dental conditions represent a noteworthy proportion of travel insurance claims made by Australian travellers abroad. More than three-quarters of claims for dental conditions were for conservative, endodontic or prosthodontic treatment. Travellers should be advised to have a dental check-up before departure overseas and to take care with pre-existing dental conditions, which may not be able to be claimed on travel insurance.

Rôle de l’industrie des aliments pour les animaux de compagnie dans l’amélioration de l’hygiène bucco-dentaire

Rôle of pet food industry in improving oral health Oral health is a subject of concern not only for vets and pet owners but also for the pet-food companies. They try to reduce the incidence of oral diseases by developing products with proof of scientific efficacy. The main steps of research and development of a dry dental food are : first define the characteristics of the food, then measure the quality and at the end, measure its efficacy on plaque and tartar accretion over a defined period. Some examples of products with dental claims developed by pet-food companies are presented.

Medicaid Costs Associated with the Hospitalization of Young Children for Restorative Dental Treatment Under General Anesthesia

This paper examines the cost to the Iowa Medicaid program of hospitalizing young children for restorative dental care under general anesthesia, and describes the dental services received in this setting. Medicaid dental claims for young children receiving restorative dental care under general anesthesia during fiscal year 1994 were matched with corresponding hospital and anesthesia claims. The total cost to the Medicaid program of treating a child in the hospital under general anesthesia was $2,009 per case. Less than 2 percent of Medicaid-enrolled children under 6 years of age who received any dental service accounted for 25 percent of all dollars spent on dental services for this age group, including hospital and anesthesia care. The most frequent type of procedure was stainless steel crowns (SSCs), with an average of almost six per case. Early identification, prevention, and intervention are critically important to prevent the costly treatment of children with ECC in hospital operating rooms.

Predetermination of Insurance Benefits for Oral and Maxillofacial Surgery

Summary In this discussion of predetermination of insurance benefits, the author explores the scope of the problem from an historical perspective. The concept of attractive inducement as applied to the medical plan and its relation to inappropriate claims submission is introduced. The author stresses the deleterious contributions of fraud and uncertainty in insurance claims submission. Direction is given for the appropriate submission of predetermination of medical and dental claims for surgical procedures.

Validity of a questionnaire survey: the role of non-response and incorrect answers

Errors in questionnaire surveys are usually of one of two sources: non-responses or incorrect answers. The aim was to investigate the validity of a questionnaire survey and to estimate the respective bias of these answers. Of 9,283 subjects selected to receive a questionnaire by post, 3,949 (43%) responded, and, of these, 3,400 correctly reported their Swedish social security number. Answers in the questionnaire survey were given as proportions of the claims registered at local insurance offices. In the group of respondents who had correctly reported their social security number, the answers were compared individually with the registrations in dental insurance claims. In Sweden, these claims are labeled with the patient's social security number and it is thereby possible to make such comparisons. It was shown that errors were caused by non-response and also by respondents giving incorrect answers. Incorrect answers accounted for approximately one-third of the total bias. The remaining bias was caused by a non-response error. It is concluded that questionnaire studies have a bias caused by both non-response and incorrect answers and that together these can be substantial. Scientific reports that include questionnaire surveys must describe the procedure carefully. If possible, other sources of information should be considered.

A longitudinal study of schoolchildren's experience in the North Carolina Dental Medicaid Program, 1984 through 1992.

This evaluation of a state Medicaid dental program describes dental treatment received, relates treatment needed to treatment received, and describes enrollment and use over an 8-year period. Three databases were linked: (1) clinical records from a 1986/87 statewide epidemiological survey, providing data on treatment need; (2) Medicaid dental claims from 1984 through 1992, providing data on treatment received; and (3) Medicaid enrollment files from 1984 through 1992. Half of Medicaid-enrolled children never used dental services. Among users of dental services, 45% and 25% of children needed restorations in primary and permanent teeth, respectively. In this group, 29% had all needs met, 28% had needs partially met, and 43% had no needs met. Forty-six percent of children sought care for only 1 year. Federal guidelines for dental care are not met in this typical Medicaid population of short-term enrollees who use services sporadically. Programs should aim to increase use and ensure that all needed services, especially preventive procedures such as sealants, can be completed within the short period of time a child attends for care.

The Level of Anesthesia Resident Training Does Not Affect the Risk of Dental Injury

The Level of Anesthesia Resident Training Does Not Affect the Risk of Dental Injury

EDI: NOVOCAINE FOR MANAGING YOUR DENTAL CLAIMS

According to the author, submission of dental claims through electronic data interchange technology is a cost-effective way for dentists to handle some of the administrative aspects of managing their practice. Understanding what's involved can take you a long way in your decision to submit dental claims electronically now and in the future. The author outlines the advantages of EDI and gives tips on how to incorporate EDI into your office.

Developing population profiles from dental claims data for conceptualizing effectiveness of care

The purpose of this study was to explore longitudinal observational analysis of insurance claims data with goal of graphically demonstrating that effective dental care leads to the diminished use of services in subsequent time intervals. Using the Rand HIE claims data, definitions of the best patients for whom claims data would be profiled and the best parameters to use in rate calculations for the time series graphs were empirically derived. Profiles using these definitions were found to be very similar to a conceptual model of such profiles.

The influence of dentist supply on the relationship between fluoridation and restorative care among children.

Because fluoridation effectively reduces dental caries among children, it may also reduce their demand for dental care. The authors tested this proposition among 985 insureds aged 9 to 14 in Washington State using dental claims from 1982 to 1985. In the sample almost two thirds of the children with continuous fluoridation exposure lived in markets with the smallest number of persons per dentist. Relative to other children, these children received more diagnostic and preventive services and had the highest probability of receiving restorative care. Among children who received restorations, children in this group had the fewest restorations. While the last result reflects expected reductions in caries due to fluoridation, the others may reflect providers' response to less tooth decay and increased competition for patients.

Epidemiologic study of dental emergencies among utilizers in an insured population in Washington, USA.

This is a study of the epidemiology of dental emergencies based on information abstracted from the microfilmed dental claim forms of a large American insurance program in 1981-82. Overall, about 4% of all dental visits were classifiable as emergencies. There were significant seasonal and age variations in dental emergencies. There was no variation with respect to geographic regions in the State of Washington (USA) or sex. Paradoxically, residents in regions having fluoridated water supplies were at equal risk of developing dental emergencies due to dental caries, relative to those residing in non-fluoridated regions. There was also no difference in risk associated with insurance deductibles, although generally deductibles are thought to deter first-contact visits.

The validity of the radiographic method in the pretreatment review of dental claims.

The validity of the radiographic method in the pretreatment review of dental claims.

Forensic Odontology in Canada

SummaryThe historical review reveals a number of forensic applications in dentistry: the identification of corpses by comparing dental evidence with dental records; identification of victims in large-scale disasters, such as plane crashes; examination of bite mark evidence in homicide, rape, child abuse, and other cases; identity; analysis of dentures found at crime scenes; and settlement of claims involving oral injuries (e.g., insurance and dental malpractice claims). A recent development in forensic dentistry has been the analysis of lip prints. Canadian dentists have been involved in research on sex differentiations by jaw measurements, aging and tooth coloration, epidemiologic studies of teeth, presentation of bite mark evidence, handedness and exogenous stains on teeth, and other topics. It is pointed out that forensic odontology in Canada is becoming an acknowledged scientific discipline. Photographs illustrating dental evidence are included.