The ADA and HMO dentist's

[thepeople]

I have a few questions about dentist’s in the USA, HMO’s and the ADA.

1) What is the primary regulatory board for US dentist’s (if any exists), How are Dentists regulated and by
what body?

2) Are HMO dentist’s required to be members of the ADA?

3) My dentist is a member of my insurance’s HMO network, and was assigned to me by my HMO
insurance.
My dental insurance lists covered services by ADA code number. Is my Dentist required to use my plans ADA code’s to identify the treatments provided to me for billing if he is a member of the ADA and of my HMO network ?
4) Are ADA Dentist's required to use ADA billing codes when billing HMO insurance?

Thanks,

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[DrJeff]

I have a few questions about dentist’s in the USA, HMO’s and the ADA.

1) What is the primary regulatory board for US dentist’s (if any exists), How are Dentists regulated and by
what body?

2) Are HMO dentist’s required to be members of the ADA?

3) My dentist is a member of my insurance’s HMO network, and was assigned to me by my HMO
insurance.
My dental insurance lists covered services by ADA code number. Is my Dentist required to use my plans ADA code’s to identify the treatments provided to me for billing if he is a member of the ADA and of my HMO network ?
4) Are ADA Dentist's required to use ADA billing codes when billing HMO insurance?

Thanks,

#1 - Dentists are regulated essentially by their state boards, not a national board

#2 - No dentist is required to be a member of the ADA. Currently about 70% of US licensed dentists voluntarily choose to be ADA members

#3 - All dental billing is done by what I'm sure you're referring to as an "ADA Code" which is actually known as a CDT (Code on Dental Procedures and Nomenclature)

#4 - All billing to all dental insurance types (HMO's, PPO's Fee for Service, etc) is done through the CDT codes - it is the industry standard