Cross Over Dental Enterprises, LLC. (C.O.D.E.) was founded to meet the growing need of dental practitioners and dental specialists to submit specific claims to medical insurance companies for services not compensated by dental insurance.
During the last decade the dental industry advanced dramatically in terms of diagnostic abilities and treatment. The new equipment, technology, and techniques changed dentistry in many ways that were positive for both patient and practitioner. Patients were now able to receive treatment that was unfathomable 20 years ago in a dental office. Many services previously performed in hospitals or solutions that simply did not exist began being found in dental office throughout the United States. The new technologies developed, such as the in office computerized tomography scanning (CT scan), provided dental practitioners the ability to diagnose a wider range of oral and maxillofacial issues. A positive consequence to this new diagnostic ability was the development of new methods for treatment of issues such periapical abscesses, bruxism, and edentulous individuals whether partial or full. While this evolution occurred in dental offices, dental insurance companies, that are the primary form of reimbursement for many dental offices, did not meet the needs of these new services via reimbursement. In today’s current dental insurance climate there is usually no reimbursement for services such as the CT scan, bone grafts, and sleep apnea appliances. Also, the most common dollar amount provided for dental treatment in the United States by Preferred Provider Organizations (PPO’s) is $1500.00 per calendar year. This is approximately the same amount of money that has been provided by the dental PPO insurance companies since the 1970’s.
Medical PPO insurance plans typically have no limit on benefits reimbursement. Medical insurance does not often have restrictions that exist for dental insurance companies such as certain imaging performed on the same day as other imaging or a limit on the number of office visits per year. Some procedures are completely not covered by dental insurance and therefore must be submitted to medical insurance for any type of insurance reimbursement.
You have many options with billing medical insurance. You may purchase expensive software to learn how to do it yourself. You may dedicate significant hours and staff training time to learn how to submit a claim. You may not know this, but there are computer programming codes that medical insurances utlilize that can automatically deny your claim! Most other platforms stop at this point and no longer pursue such claims. C.O.D.E. on the other hand knows exactly how to achieve the benefits your clients are entitled to. Most of our representatives' efforts are spent on pursuing these denials. You simply can't afford to spend the time to do this yourself, and your staff can focus their resources on more productive matters. Best of all, we don't get paid beyond your registration fees, until you get paid. This means that we only charge you for successfully processed claims for the net amount of payment that is rendered, so you know we have your best interests at hand.