🇦🇺Australia

Prior Approval Delays

2 verified sources

Definition

DVA requires fully completed multi-provider forms with OPG scans and treatment plans for dental implants; incomplete forms are returned to the restorative provider, delaying approvals and preventing treatment commencement without prior grant.

Key Findings

  • Financial Impact: 10-20 hours/month per practice on form handling and resubmissions; equivalent to AUD 1,000-2,000/month at AUD 100/hour dentist rate
  • Frequency: Per major procedure request, especially DVA veterans' implants limited to 2-3 per patient over 2 years
  • Root Cause: Manual coordination between restorative and surgical providers, mandatory documentation like OPG and treatment plans

Why This Matters

The Pitch: Dentists in Australia 🇦🇺 lose 10-20 hours per month on manual pre-authorization forms and resubmissions. Automation of form completion and submission eliminates this capacity loss.

Affected Stakeholders

Dentists, Prosthodontists, Oral Surgeons, Practice Managers

Deep Analysis (Premium)

Financial Impact

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Current Workarounds

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Patient Treatment Delays

AUD 2,000-5,000 per lost implant case (avg implant revenue); 5-10% client churn from delays

Claim Denial Risks

AUD 500-5,000 per denied major procedure claim; 6-week SA claim processing window

Fines for Non-Compliance with Dental Regulations

AUD 5,000-50,000 per breach in fines and legal costs; 20-40 hours per audit preparation

Penalties for Using Non-TGA Approved Dental Devices

AUD 10,000-100,000 fines per violation; inventory write-offs of 5-10% stock value

Costs from Informed Consent and Record-Keeping Failures

AUD 5,000-30,000 per legal claim or compensation; 10-20 hours per incident documentation

Einnahmeverluste durch abgelehnte oder gekürzte Zahnleistungsansprüche wegen fehlerhafter CDT-Codierung

Quantified: Typischerweise 2–5 % des jährlichen Versicherungsumsatzes als nicht realisierte Erlöse; bei einem Praxisumsatz von AUD 1 Mio. entspricht dies etwa AUD 20.000–50.000 pro Jahr an verlorenen oder gekürzten Erstattungen.

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