Whitepaper

This whitepaper covers one of the recent changes made by Molina Healthcare, a health insurance company that affected the processing of dental claims under Medicaid. According to the ADA, since April 1, 2023, dentists must attach an ICD-10 diagnosis code to each claim in addition to the CDT code that is already used.

CDT codes define what was done to the patient, while ICD-10 codes define why that had to be done to the patient. This change is to improve the accuracy of billing and to assist the insurance company in having a better perception of the condition of the patient. It also allows the offices of dental offices to be paid quickly with little or no rejection from the insurance companies.

So, why did Molina make this change?

ICD-10 codes are already used in most medical claims. They provide a clear view of a patient’s health and make for better monitoring of diseases and treatment. With this utility being added to dental billing, Molina expects to improve the quality of patient care on an overall basis and improve the claim process as well.

This move aligns dental billing with the way things are in common healthcare. It eliminates confusion, and it ensures the dental process is supported appropriately by a reason or diagnosis.

What does this mean for dental offices?

To dentists and their teams, it may appear a little difficult initially. If you have not used ICD-10 codes before, getting used to them can take time and can require some work. There are thousands of codes, and the choice of which one to use in any given situation is not that simple.

However, there’s not all bad news. There are a lot of benefits once your team gets hold of the ICD-10 code usage. Claims are more likely to get approved the first time, payments come faster, and your office spends less time fixing errors or following up on rejected claims.

Here are some of the main benefits of the update:

• Better patient care – Using diagnosis codes gives a clearer picture of what your patient is dealing with. That means better planning and treatment decisions.
• More accurate records – With both the procedure and the reason for it included, your records become more complete and helpful.
• Fewer claim denials – When your claims show exactly what was done and why, insurance companies have less reason to deny them.
• Faster payments – Clear, correct claims get processed quicker. That means your office sees revenue sooner.

What are the challenges?

There might be some learning curves due to any change. The front staff in smaller practices may not know enough about ICD-10 codes, and it can be a long way before they get some needed training. It might even slow things down at first. But putting in that effort now can save your team a lot of time and frustration later.
Another challenge is the number of codes themselves. There are thousands, and picking the right one matters. Selecting the incorrect code could slow down or reject applications. That’s why training and support are important during this transition period.

What can dental practices do to stay ahead?

Start learning now. The sooner your team gets used to this new system, the better. There are online training programs that walk you through the code and show you how to use it. You can also find reference materials that explain which codes to use in different situations.

But if you’re short on time or resources, outsourcing your billing may be the smartest move. Professional billing companies already have trained coders who know how to handle ICD-10 requirements. They stay up to date with the latest rules and can help your practice avoid costly errors.

Capline Healthcare Management can help

Capline has already been helping dental offices across the country handle changes like these. Their certified coders and billing experts are experienced with both CDT and ICD-10 codes. They’ve worked with other Medicaid programs that use the same rules and know how to get claims submitted correctly the first time.

Offices that work with Capline see fewer claim denials and faster turnaround times. That means more time to focus on patients and less time worrying about paperwork.

Why wait?

This update is already active. If your office is not prepared, this could cause a delay in payment and additional work for your team. But if trained and supported adequately, you can do this challenge positively. Better records, better care, and faster billing are all possible with the proper use of ICD-10 codes.

If you want the full picture, including how to make the switch, examples of successful transitions, and steps to avoid common mistakes, download the full whitepaper now.

This guide is designed to help you understand everything you need to know about Molina’s new billing rule and how to adapt with confidence.

Ready to take the next step? Get your copy of the whitepaper today and prepare your practice for smoother billing and stronger reimbursements.