Difference between ADA and MBS Claim

Overview
Health care in Australia is delivered by a mix of public and private sector entities and is funded by all levels of government, private health insurers, and out-of-pocket payments by individuals.

Especially in the Dental Service Sector, the Dental Benefits Schedule is based on the Australian Dental Association Australian Schedule of Dental Services and Glossary, 12th Edition.

Concept
The Australian Dental Association (ADA) is a not-for-profit professional membership organisation. The ADA assigns a three-digit code number to items or clinical procedures it considers to be part of current dental practice and is governed by the Federal Council, which is responsible for the strategic direction, vision, and high-level operation of the Association.

While the Medicare Benefits Schedule (MBS) is a key component of the Medicare system and has a list of fees for medical services set by the Government. Medicare uses a variation of the ADA codes for its claiming purposes. They prefix every ADA code with 88. For example, CDBS item 88011 corresponds to Australian Dental Association item 011.

Due to certain restrictions and limitations of both institutes, a provider or dental practitioner cannot process a claim with normal treatment (ADA) alongside Medicare (88) items. Below is a sample if you will process an invoice with ADA items and MBS items at the same time; in order to proceed you will need to choose the item type.



To set your items to Medicare, follow this article on How to set Medicare Items.

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