Substantiating dental services provided under the Child Dental Benefits Schedule (CDBS).

This guideline outlines what you can do to substantiate claimed CDBS services and that consent to dental services and costs was obtained.

Page last updated: 03 July 2017

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What you need to know

The guideline is not exhaustive and you can respond to a health provider compliance audit or review using any additional documentation you think substantiates compliance.

However, we may determine that more information is needed and may request additional documentation to substantiate dental services you have claimed. Eligible dental providers must maintain adequate records for at least 4 years from the date of service.

Read more about the Child Dental Benefits Schedule for health professionals.

Documents you may use to substantiate a claim

Any document you give us should have been created during or as soon as practicable after the dental services were provided. It should include the patient's name and the date the dental service was provided.

Treatment evidence

Documents you can provide to substantiate a dental service has been provided to a patient include one or more of the following:
    • a signed patient consent form
      showing that consent for the dental services, including likely costs and billing arrangements for the practice from the patient or the person responsible for the account such as a patient’s parent or guardian has been obtained at the time of providing any dental services
    • an excerpt from the patient’s clinical file
      clearly showing the patient’s name, date each dental service was provided, description of each dental service provided or the Dental Benefits Schedule item number corresponding to the service, dental provider’s name and provider number
    • a copy of the bulk bill form
      clearly showing the patient’s name, date each dental service was provided, description of each dental service or the Dental Benefits Schedule item number corresponding to the service, dental provider’s name and provider number and the amount of the dental benefit being assigned to the dental provider
    • a copy of the account or receipt
      clearly showing the patient’s name, date each dental service was provided, description of each dental service or the Dental Benefits Schedule item number corresponding to the service, dental provider’s name and provider number and the amount charged in respect of the dental service, total amount paid and any amount outstanding in relation to the dental service

Evidence of patient consent

Documents you may provide to substantiate consent to dental services and informed financial consent include the following:
    • a signed patient consent form showing that at the time of providing any dental service, the patient or the person responsible for the account, such as the patient’s parent or guardian, agree to the costs and billing arrangement for the practice

Extenuating circumstances evidence

Documents you may provide to substantiate an extenuating circumstance where consent was not recorded include the following:
    • an excerpt from the patient’s clinical file. In some cases you may not be able to provide the patient consent form. There are specific extenuating circumstances where consent can be substantiated by providing an excerpt from your patient’s clinical file. Read the Child Dental Benefits Schedule Ministerial guidelines on this website.

Using your patient’s clinical file

In most cases, a patient's clinical information will be the only way to confirm a dental service has been provided, and to substantiate that you received the correct benefit.
If you need to use a patient's clinical information, you can censor any details that you think aren't relevant. You can also choose to provide the information to one of our dental or medical practitioners.

Formal notice to produce documents

Under section 32C of the Dental Benefits Act 2008, if we have reasonable concern that you've been paid a benefit that exceeds the amount you should have been paid, we can ask you to substantiate your claims.

A formal notice to produce documents will be issued if you don't provide substantiating documents for a provider compliance audit or review. This is part of our compliance audit and review processes.

Read more about our compliance audit and review processes.

Voluntary acknowledgement

A voluntary acknowledgement is when you tell us if you have incorrectly claimed and received a payment you shouldn't have received. If you think you've incorrectly claimed a benefit or received a payment you were not eligible for, it's important you let us know as soon as possible, by submitting a Voluntary Acknowledgement of Incorrect Payments form. This form can be used at any stage you become aware that you’ve incorrectly claimed a benefit or received a payment.
Read more about voluntary acknowledgement of incorrect payments.

Resources

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Supporting legislation

Legislation supporting the administration of the Child Dental Benefits Schedule include the Dental Benefits Act 2008 and Dental Benefits Rules 2014.
You can access the legislation by searching on the Federal Register of Legislation website.