1. Orthodontic Claims Attachment IG

2. Current state of Dental Attachments
Dental Provider
Insurer
Bill/Claim
Request for supporting Documentation
Screenshots, Images, and/or Scanned Charts
(someone needs to read)
Claim Response / Payment

3. Future state of Dental Attachments
Dental Provider
Insurer
Bill/Claim
Request for supporting Documentation
Computable HL7 CDA with Dental Observations
(systems can process)
Claim Response / Payment

4. Orthodontic Attachment IG Purpose
Elaborate with specificity how the Orthodontic exams needed by payers should be expressed in a CDA format
Align with the ADA guidance for Dental Claims Attachments:
ANSI/ADA Standard No Standard Content of Electronic Attachments for Dental Claims - ADA
Create an IG that would give developers, payers, and providers the construct to send this data in a structured data context within an attachment in support of a X12 electronic claim
Align to existing STU Periodontal Attachment IG

5. ADA 1079 Data Requirements: Yes/No Observations
Possible Orthognathic Surgery
Oral Hygiene Acceptability
Temporomandibular dysfunction
Presence of caries or need for replacement of restorations
Other Medical conditions
Habits
*Deep impinging overbite with destruction of soft tissue
*Crossbite of individual anterior teeth with destruction of soft tissue
*Severe traumatic deviations
*Overjet greater than 9mm with incompetent lips or reverse overjet greater than 3.5mm
*Posterior unilateral crossbite
*Upper or lower teeth protruding so much that lips cannot be brought together without strain
*Marked asymmetry of lower face
*Marked recession of gums
*Lisping or other speech articulation errors in children 9 years or older
*History of or recommendation for speech therapy
*Airway issues, e.g., snoring, sleep apnea, mouthbreathing
* = Part of HLD Index

6. ADA 1079 Data Requirements: Coded Value Observations
Type of Benefits
Case study only (orthodontic records)
Interceptive treatment
Limited treatment
Comprehensive treatment
Transfer case
Stage of Dentition
Primary (deciduous)
Mixed (transitional)
Permanent
Tooth-specific Abnormalities (including tooth number)
Ectopic Eruption
Missing
Impacted …
Craniofacial anomalies
Cleft lip/palate
Condylar abnormality
Hemifacial macrosomia

7. ADA 1079 Data Requirements: Numeric Measurement Observations
Overjet (mm)
Overbite (mm)
Open bite (mm)
Spacing – Maxilla (mm)
Spacing – Mandible (mm)
*Anterior crowding – Maxilla (mm)
*Anterior crowding – Mandible (mm)
*Labiolingual deviation (mm)
Salzmann Index (integer)
* = Part of HLD Index

8. ADA 1079 Data Requirements: Narrative Observations
Orthodontic Narrative (1000 characters)
“Free Text” (possibly scanned images or text?)
Narratives
Consultations
Letters from general dentist/orthodontist/primary care provider/behavioral health specialist/speech therapist
Test results such as sleep study/genetics reports
Periodontal charting
Agency forms

9. Proposed Schedule 2018 2019 2020 Publish Normative Publish STU
STU Ballot
Normative Ballot
Implementation Feedback
Complete STU Reconciliation
Complete STU Reconciliation

10. Questions? Russ Ott – rott@deloitte.com
Nancy Orvis –
Jean Narcisi -