Dental Claims Management

ClaimSecure’s dental claims management system provides Canadian health benefit plan sponsors and their plan members with unparalleled coverage, speed of service and quality control. Our online, real time dental claims adjudication system is connected to more than 65% of licensed dentists across Canada. Every electronically transmitted dental procedure is subjected to rigorous checks and audits before the claim is accepted, adjusted or declined.

Key Features:

Coast to Coast Coverage – ClaimSecure’s pay direct health benefit card is recognized and accepted across Canada, and we perform real time claims processing using the most advanced adjudication protocols available.
Rigorous Standards – ClaimSecure’s dental claims management system is designed to ensure that member/dependant eligibility, procedure code eligibility, and specific cost containment measures are strictly adhered to within each dental office.
Speed and Functionality – ClaimSecure’s leading edge system allows dental claims to be submitted directly from the dentist’s office immediately following a procedure. The claim is adjudicated by ClaimSecure online, in real time, and the adjudication results are immediately transmitted back to the dental office. All transaction data is then stored in the central data warehouse for reporting, invoicing and analysis.

Flexible Plan Design Options:

ClaimSecure’s proprietary dental systems allow health benefit plan sponsors to select from standard plan designs or to create customized programs, including:

General Practitioner and Specialist Fee Guide adjudication
Pay member or pay provider claims payment options
Tiered co-insurance per benefit class (e.g. 100% basic, 80% major restorative, 50% orthodontics)
Co-insurance plus calendar, policy or lifetime maximum per benefit class (e.g. 100% periodontics to maximum of $500/year)
Annual or per-claim deductibles
Maximums:
- Annual
- Per certificate
- Per individual
- Per benefit class (e.g. endodontics)
Private coordination of benefits