Einnahmeverluste durch abgelehnte oder gekürzte Zahnleistungsansprüche wegen fehlerhafter CDT-Codierung

Definition

International dental billing guidance shows that incorrect or outdated CDT codes are a persistent cause of claim denials and reduced payments, because insurers only pay for services that are properly coded and supported by documentation.[1][5][6][8] Claims missing required CDT codes or using retired codes are often rejected outright, or the insurer reimburses at a lower‑value alternative code. In Australia, many dental practices interact with overseas‑backed or policy‑driven coding frameworks (and local fee schedules) that mirror CDT logic; when claims are submitted with coding errors, the end result is the same: unreimbursed chair time and write‑offs. If a practice has annual billings of AUD 1–2 million and even 2–3 % of claims value is chronically denied or written off due to coding/documentation defects, this equates to AUD 20,000–60,000 per year in avoidable revenue leakage.

Why This Matters

The Pitch: Dental providers in Australia 🇦🇺 waste schätzungsweise 2–5 % ihres abrechnungsfähigen Honorarvolumens pro Jahr durch falsch oder unvollständig codierte CDT‑Leistungen in Versicherungsansprüchen. Automation und regelbasierte Prüfung der CDT‑Codierung vor Einreichung eliminieren diese Verluste weitgehend.

Affected Stakeholders

Zahnärzte, Praxismanager, Abrechnungs- und Empfangspersonal, Externe Abrechnungsdienstleister

Related Business Risks