Ortho claims must be submitted manually each month to Beam Benefits.
Submit the monthly ortho claims like any other claim but use the ADA code for monthly ortho service.
Note: The dentist has to use one ADA procedure code for the banding date, and a different one for monthly treatment.
Once the banding date claim information is received, a treatment plan will be created in the Beam system, and we will pay 25% of the patient's lifetime ortho max towards the banding date claim.
Here's an illustrative example of how ortho payments work at Beam:
Patient’s total cost for orthodontic treatment is $4,000. The dentist is going to do monthly adjustments to the braces for a total of 48 months. On the patient’s insurance plan, they have a lifetime maximum for ortho of $2,000 with a 50% coinsurance cost. In this case, 50% of the total cost equals the lifetime max.
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Beam pays 25% of the total lifetime max to the banding date claim
- $2,000 x 0.25 = $500 (banding date payment)
- Then, Beam divides the remaining lifetime max over the number of months of ongoing treatment
- $1,500 / 48 = $31.25 (Beam's monthly payment)
- The provider's office will submit a monthly claim to Beam and Beam will payout the calculated monthly payment