Frequently Asked Questions
What conditions must be met for a claim to be paid by Dentaide?
- The dentist must be a Dentaide member.
- The insurer must be a Dentaide participant.
- The group (insured’s employer) must offer its employees the Dentaide direct payment option.
- When the transaction has been transmitted, you must receive an “explanation of benefits” that provides a confirmation number AND the total amount reimbursed.
When sending a claim, why do certain insurers occasionally specify that the claim is pending? This creates more administrative work for our office.
Insurers may postpone their response to a claim so that they can check on additional information. They usually do so on a random basis or depending on their claims management system. Dentaide has no control over this.
When a claim is pending, how much should I charge the patient?
At all times and regardless of the insurer concerned, you should charge the entire cost of the dental care. There are two reasons for this:
- You do not know the amount that will be reimbursed by the insurer.
- It is easier and faster for you to reimburse patients if you receive a second payment from the insurer than to recover your fees from your patients.
As a follow-up to question 2, it is incorrect to say that that I do not know the amount that will be reimbursed by the insurer because the insurer previously provided this information in its response to our treatment plan request (predetermination).
The insurer’s response to a treatment plan request (predetermination) is neither a claim nor a payment guarantee. Its sole purpose is to inform the insured of the amount that will be reimbursed by their insurance provider for the care they are to receive.
Everything is decided when the claim is transmitted, which is after the patient has received the care!
- Did you receive a confirmation indicating the amount that will be reimbursed? Charge your patient for only the portion of the care that is not covered by their insurance.
- Is the claim pending ? Charge your patient for the total amount of the care and ask them to contact their insurer to obtain their reimbursement.
My patient was furious when I charged him the total amount for the care because the claim was pending. What can I do?
The insurer’s response to the insured is not your concern. Ask your patient to contact his insurer or the administrator of his employer’s plan in order to find out why a direct payment was not authorized this time.
Is it true that claims over $1,000 are not reimbursed through Dentaide?
We confirm that claims over $1,000 are definitely reimbursed through Dentaide.
Did you receive an “explanation of benefits” with a confirmation number AND the amount that will be reimbursed?
- If you did: The claim will be included in the Dentaide payment.
- If you did not: This means that the claim is pending and that you must charge the patient the total amount.
NET + ACDQ
With Net+ACDQ, can I send claims electronically to all insurers? Or only to insurers that participate in the Dentaide program?
Net+ ACDQ can be used to send claims electronically to all insurers that accept transactions from Net+ACDQ, which is most of them.
Do we have to subscribe to Net+ ACDQ?
Since Telus announced the end of telephone modem service, it will no longer be possible to electronically submit claims to insurers by modem. The ACDQ recommends that you use the private Net+ ACDQ network because it is the most reliable way to electronically submit claims to insurers.
How is Net+ ACDQ installed? What kind of IT equipment do I need?
Once you subscribe to Net+ ACDQ, we will send you documents with detailed descriptions of the procedure. We will coordinate everything with your installer. The installer will visit your office twice: a pre-installation visit to take an inventory of your hardware and software and make sure that they meet Net+ ACDQ’s minimum requirements, and another visit to install your router, which may take one or two hours.
If you do not have an installer, we can supply a list of approved installers in your area. Net+ ACDQ service centre agents will also be available to assist you throughout the installation process.
- Use an operating system whose manufacturer provides technical support;
- Comply with the minimum hardware requirements recommended by software providers;
- Use and continuously update anti-virus, anti-spyware and anti-malware products that are certified for the versions of the operating system you use;
- Use an updated Internet browser whose manufacturer provides technical support.
How does it work if I already have a firewall?
The Net+ACDQ router is alone capable of countering threats from the Internet. You can discuss this topic with your installer to determine the best configuration for your office.
Once it is installed, does the Net+ ACDQ service monitor my office’s Internet traffic?
We monitor Internet traffic. The sole purpose of this monitoring is to detect viruses and malware that circulate on the Internet and could adversely affect your business. We never monitor your browsing history.
Who should we contact for transmission or Internet problems?
Our team of technicians is available to provide you with the support you need for basic Net+ ACDQ services, at no additional cost. We will analyze the situation and try to resolve the problem. If we are unable to do so, we will determine which other stakeholders need to be contacted: software manufacturer, Internet service provider or technician.
I am a Net+ ACDQ subscriber and I have to switch Internet service providers. Will my electronic transmissions be affected?
You must notify us in advance of any changes so that we can plan a smooth transition and ensure that your connection and your office’s productivity are not affected.
Why do I now have to log on to the Net+ ACDQ portal to access the Internet?
Logging on to the portal is the best way to control Internet access. It is also the most reliable way to restrict browsing on certain sites and thus protect your IT network.
Will the network or electronic transmissions be affected if I upgrade my computer from Windows 7 to 10?
Electronic transmissions already work with Windows 10. We recommend that you check with your software provider to find out if there are any other potential repercussions.
Can my IT system become infected by ransomware?
The Net+ACDQ network is highly secure, which greatly reduces the risk of being targeted by such online attacks. However, to protect your IT system against infection from local sources such as infected USB keys, CDs or laptops, your dental office must have regularly updated anti-virus software.
By activating structured access, you add an additional security layer that lowers the risk of your employees spreading such online viruses across all your computers.