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Aetna Offers Solution to Suit

The carrier's settlement with the ADA aims at communications clarity.

Having already come to terms with physician providers over business practices earlier this year, Aetna has arranged a settlement with the American Dental Association (ADA)-the largest dental provider organization in the country-and will use technology to speed payments to dentists and reduce administrative complexity.

Key elements of the settlement include the establishment of a Dental Advisory committee to provide advice to Aetna on issues of concern to dentists; a commitment to timely processing of "clean" claims; initiatives to reduce claims resubmission; disclosure of claims-editing policies, procedures and practices; and increased electronic connectivity and direct Web-enabled access to Aetna systems to verify reimbursement information and track claims. The carrier will also pay $4 million to dentists and $1 million to the ADA Foundation.

Transparency & Efficiency

Aetna views the settlement not so much as an admission of wrong as an affirmation of a good-faith approach to dealing with its providers, according to Scott Schnuckle, head of Aetna Dental. He asserts that through the use of technology, the settlement provides not only transparency but also efficiencies that result in a win/win for the carrier and its providers. "We have a common goal and the settlement provides the opportunity for us to deliver that goal," Schnuckle says.

Aetna currently is developing the capability to receive claims and inquiries through the Internet and other channels that normally would need to be handled by phone, according to Schnuckle. The idea, he says, "is to enable the dentist community to do much of their work the day before rather than the day of a visit, which removes hassles for both patient and dentists."

Other efforts include driving up electronic claims submission through conversion of paper claims into electronic format. "Through our systems design, we're trying to drive the highest possible level of auto-adjudication, removing the human touch element responsible for error and ensuring a very quick turnaround and great cash flow to the dentist community," Schnuckle remarks.

The settlement is another step in Aetna's turnaround from the heavy losses it suffered two years ago. And just as Aetna seeks to put itself at the forefront of the consumer-directed healthcare trend, the use of technology in connecting with providers is also key. "Technology is a cornerstone of ensuring that we have an improving partnership with the dentist community," according to Schnuckle.

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek Financial Services of TechWeb he has written on all areas of information ... View Full Bio

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