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dc.contributor.authorunicampMiranda, Geraldo Elias-
dc.contributor.authorunicampDelwing, Fábio-
dc.contributor.authorunicampDaruge Junior, Eduardo-
dc.titleAdministrative and clinical denials by a large dental insurance providerpt_BR
dc.contributor.authorMiranda, Geraldo Elias-
dc.contributor.authorSiqueira, Marta Cristina Portes-
dc.contributor.authorSiqueira Magalhaes Ferreira, Ricardo Luiz-
dc.contributor.authorDelwing, Fabio-
dc.contributor.authorDaruge Junior, Eduardo-
dc.subjectOdontologia legalpt_BR
dc.subjectAuditoria odontológicapt_BR
dc.subject.otherlanguageForensic dentistrypt_BR
dc.subject.otherlanguageDental auditpt_BR
dc.description.abstractThe objective of this study was to assess the prevalence and the type of claim denials (administrative, clinical or both) made by a large dental insurance plan. This was a cross-sectional, observational study, which retrospectively collected data from the claims and denial reports of a dental insurance company. The sample consisted of the payment claims submitted by network dentists, based on their procedure reports, reviewed in the third trimester of 2012. The denials were classified and grouped into ‘administrative’, ‘clinical’ or ‘both’. The data were tabulated and submitted to uni- and bivariate analyses. The confidence intervals were 95% and the level of significance was set at 5%. The overall frequency of denials was 8.2% of the total number of procedures performed. The frequency of administrative denials was 72.88%, whereas that of technical denials was 25.95% and that of both, 1.17% (p < 0.05). It was concluded that the overall prevalence of denials in the studied sample was low. Administrative denials were the most prevalent. This type of denial could be reduced if all dental insurance providers had unified clinical and administrative protocols, and if dentists submitted all of the required documentation in accordance with these protocolspt_BR
dc.relation.ispartofBrazilian oral researchpt_BR
dc.relation.ispartofabbreviationBraz. oral res.pt_BR
dc.publisher.citySão Paulo, SPpt_BR
dc.publisherSociedade Brasileira de Pesquisa Odontologicapt_BR
dc.description.provenanceSubmitted by Cintia Oliveira de Moura ( on 2020-12-15T18:31:47Z No. of bitstreams: 0. Added 1 bitstream(s) on 2021-02-19T19:00:40Z : No. of bitstreams: 1 S1806-83242015000100232.pdf: 358894 bytes, checksum: bcd7a546efa3c3b4ea5782024439f556 (MD5)en
dc.description.provenanceMade available in DSpace on 2020-12-15T18:31:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2015en
dc.contributor.departmentsem informaçãopt_BR
dc.contributor.departmentsem informaçãopt_BR
dc.contributor.departmentDepartamento de Odontologia Socialpt_BR
dc.contributor.unidadeFaculdade de Odontologiapt_BR
dc.contributor.unidadeFaculdade de Odontologiapt_BR
dc.contributor.unidadeFaculdade de Odontologiapt_BR
dc.creator.orcidsem informaçãopt_BR
dc.creator.orcidsem informaçãopt_BR
dc.type.formPesquisa originalpt_BR
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