When submitting a claim, DBP uses a three-point match process to determine if a claim should be processed in network. These three items must be a match to their internal records in order to ensure that claims are adjudicating accurately. The goal of three-point matching is to highlight any discrepancies in three important elements of a claim. If the information provided on the claim form is not an exact match of all three items listed below, a new provider record will be created and paid out of network.
The three-point match must include exact matches of the following data:
- Rendering Provider Name
- Tax ID
- Treatment/Billing Address
Common reasons for claim mismatches include:
- Use of nicknames
- In Network dental provider records will match the name as shown on the license.
- PO Boxes for treatment address
- Treating locations should never be a PO Box.
- Tax ID mismatch.
- The Tax ID that is submitted with the claim should be an exact match with the IRS database. Incorrect data will cause discrepancies when filing taxes for the office.