Organizations ask CMS to consider dental practices' needs in proposed prior authorization rule

The American Dental Association and the American Academy of Pediatric Dentistry have asked CMS to consider the needs of dental practices in the organization's proposed prior authorization rule.

CMS' proposed rule aims to streamline the prior authorization process and promote interoperability.

On March 13, ADA President George Shepley, DDS, and AAPD President Amr Moursi, DDS, PhD, wrote a joint letter on behalf of their organizations to CMS to offer guidance on how the proposed rule can be improved to better aid dental practices.

Six things to know, according to a March 21 article from the ADA:

1. Both organizations urge CMS not to exclude stand-alone dental plans from the proposed rule. They encouraged CMS to offer technical assistance, financial incentives and time-limited safe harbor periods to help the plans meet the requirements of the final rule, which would prevent stand-alone dental plan attrition.

2. The organizations asked CMS to recognize that the current Patient Access Application Program Interface might not be capable of representing all the vital benefit information for dental.

3. The ADA and AAPD requested that CMS move to at least United States Core Data for Interoperability version two to encourage the dental industry to ensure that the data elements and classes made available through the Patient Access Application Program Interface are the most appropriate for information exchange. They also asked CMS to ensure that those who use the United States Core Data for Interoperability version two know that CDT is optional only for systems that do not handle any dental data.

4. The ADA and AAPD approve of CMS' efforts to promote the adoption of Fast Healthcare Interoperability Resources-based application programming interfaces. The groups said that they hope the HL7 Fast Healthcare Interoperability Resources Application Program Interfaces for prior authorization will expand to include dental.

5. Both organizations support gold carding programs for prior authorization as they believe it can help smaller practices improve efficiency. The groups recommended the gold carding measure mimic the one used in the Medicare Fee-for-Service Review Choice Demonstration for Home Health Services: a review affirmation rate or claim approval rate of 90 percent or more over six months.

6. The ADA and AAPD are concerned about the recommended implementation guides for the Patient Access; Provider Access; Provider Directory; Payer-to-Payer; and Prior Authorization Requirements, Documentation and Decision Application Program Interfaces. They asked CMS to offer technical support and incentives for the dental industry to pilot and validate the rule's standards.

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