By Scott D. Leeper
Practice management software vendors are one of the three primary “players” in the world of dental electronic transactions, a group which also includes insurance companies and the dental healthcare provider.

Your office, as the provider of dental health services, generates raw data in the form of insurance claims and related transactions that need to be exchanged with an insurance company.  Your practice management software organizes this data, and provides the mechanism for transferring this information in an automated and organized fashion to the insurance company. The insurance company receives the claim data electronically, and utilizes this information to satisfy the contractual financial obligations of the patients covered by dental insurance.  Practice Management Software Vendors provide the value-added services that facilitate the exchange of information between the dental healthcare providers and insurance companies.

The dental industry is one of the few remaining cottage industries in the U.S., and consists of thousands of small practices in cities throughout the country.   The computerization of these practices by the vendor community has been a significant factor in the growth of dental EDI over the past ten years.  As part of this computerization process, vendors have invested millions of dollars in software application research and development to support the dental EDI process.  These integrated solutions, which eliminate redundant data entry and minimize keystrokes, have had a significant positive influence on the adoption of electronic solutions for data exchange.  Vendors also provide ongoing hardware and software support, which is critical to the continuing growth of dental EDI.  As part of this support process, vendors continually refine and improve software validation rules for EDI transactions.  This ongoing support and constant refinement improves the quality of the transactions received by the insurance companies, and keeps dental providers current with changes made within the insurance industry.

Vendors directly market EDI services to dental providers, providing indirect marketing support for EDI for insurance companies.  Vendors also educate dental providers on the benefits of EDI services, and provide training to insure that dental providers understand how to use the services.  Vendors provide the first level of troubleshooting for the EDI process, resolving many issues related to dental EDI before they reach the payer’s help desk.  Vendors regularly communicate with their clients to keep them apprised of changes within the EDI process in the product and within the industry.  As a result of these ongoing efforts to promote and support EDI within the dental industry, the vendor community insures that providers continue to use EDI as a solution for exchanging information with the insurance companies.

The vendor community also provides the tools that allow providers to be compliant with HIPAA transaction, privacy and security regulations.  As allowed by HIPAA, vendors acting as clearinghouses provide translation services to the providers to bring their transactions into compliance.  Vendors will also play a role in helping the providers understand the administrative requirements associated with HIPAA.

In summary, vendors provide value-added services that promote and support the exchange of information electronically between the dental providers and insurance companies.  The connection of thousands of dental providers with thousands of dental payers is not possible without the software and hardware implementations created by the vendor community.  As technology evolves to utilize more advanced mechanisms for the exchange of data between provider and payer, the vendor will be the agent providing the technological solutions making this exchange possible.