RE: DENTAL LABORATORY FEES: REMINDER NOTIFICATION REGARDING THE BILLING PROCEDURE REQUIRED FOR DENTAL LABORATORY FEES FOR ALL SCHEMES AND OPTIONS ADMINISTERED BY PRIME CURE
Dear Dental Service Provider:
Please note that in order to comply with industry standards and SADA’s Professional Billing Guidelines, Prime Cure has changed their system with immediate effect regarding the payment of dental laboratory procedures for all schemes and options administered by Prime Cure. The following please need to be adhered to in order to ensure the payment of dental laboratory procedures.
1. Electronic submission:
Please note that the payment of laboratory fees claimed by any practice on behalf of a dental laboratory will only be processed for payment in the event that all laboratory procedure codes and fees feature on the electronically submitted invoice by the dentist in accordance with the SADA Billing Guideline (and not only code 8099), excerpt as follows:
Electronic submission of invoices directly to a patient or medical aid fund
The total fee charged by a dental technician for laboratory services shall be indicated on the dentist’s invoice by submitting code 8099 – Dental laboratory service with the appropriate laboratory fee on the line following the relevant dental procedure code on the date on which the dental procedure was rendered.
The technician’s invoice shall be certified by the dentist (or a person appointed by the dentist) for correctness by means of a signature. The original invoice of the dental technician shall be filed by the dentist for record purposes.
The laboratory fee shall be submitted electronically for payment on the date on which the procedure code is submitted for payment, and the appropriate dental laboratory service codes and fees shall be reported on the lines following code 8099.
2. Manual submission (“paper claims”) of invoices for direct submission to a patient or medical aid fund.
In the event of manual submission of accounts the original laboratory account (or a copy thereof) must accompany the invoice of the dentist to ensure payment for laboratory procedures as per SADA Billing Guideline excerpt below:
o The total fee charged by a dental technician for laboratory services shall be indicated on the dentist’s invoice by reporting code 8099 – Dental laboratory service with the appropriate laboratory fee on the line following the relevant dental procedure code.
o The technician’s invoice shall be certified by the dentist (or a person appointed by the dentist) for correctness by means of a signature.
o The original invoice of the dental technician (or a copy thereof) shall accompany the invoice of the dentist and a copy (or the original) shall be filed by the dentist for record purposes.
We thank you for your kind co-operation herein and should you have any queries please do not hesitate to contact our call centre at 0861 665 665
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