Singapore dental insurance & MediSave billing checklist

Singapore dental billing has more moving parts than international software typically handles. There are TPA-direct claims (Aviva, Great Eastern, AIA, AXA, Income), Integrated Shield Plan out-patient riders, MediSave for surgical work, MediSave 600 for chronic conditions, CHAS subsidies for eligible patients, and plain self-pay. Each has its own pre-auth flow, submission format, payment timeline, and audit risk.

This checklist is for the office manager or billing lead who wants to ensure every claim type is handled correctly the first time, every time. It's not tax or insurance advice — for that talk to a Singapore-qualified accountant or the relevant TPA. It's an operational reference.

Section 1 — The 6 Singapore dental payment types

Most dental visits resolve to one of these. Some visits combine them (e.g. a CHAS subsidy on top of a MediSave-claimable procedure).

1. Self-pay (cash, card, PayNow). Patient pays in full at discharge. Simplest, fastest reconciliation.
2. TPA-direct claim. Clinic submits to TPA, TPA pays clinic, patient pays nothing (or the deductible / co-payment portion). Common for Aviva, Great Eastern, AIA, AXA group dental plans.
3. Integrated Shield Plan rider.Out-patient riders cover dental in some plans. Patient typically pays upfront, claims reimbursement themselves — but some clinics handle this on the patient's behalf.
4. MediSave (surgical). For approved surgical procedures (extractions of impacted teeth, implants in some cases). Pre-auth required, MediSave caps apply.
5. MediSave 600. For chronic disease management — including some complications of diabetes that affect oral health. Specific eligibility, documented care plan required.
6. CHAS subsidy. Community Health Assist Scheme. Patient holds CHAS card (Blue, Orange, or Green tier); subsidy applies to specific dental services per the CHAS schedule. Clinic claims back from MOH/AIC.

Section 2 — TPA-direct claim checklist

At appointment confirmation (24h before)

• Verify policy is current (call TPA or check portal). Policies lapse, cards expire, employer changes — all common.
• Confirm coverage scope. “Covered for dental” is ambiguous; specifically: is this procedure code covered? Is there an annual limit? What's the co-payment %?
• Get pre-authorization number if procedure is >SGD 500 (most TPAs require for higher-value treatments).
• Set patient expectation: what they'll pay at the chair (typically deductible + co-payment), what the TPA will cover.

At discharge

• Print itemised invoice with: procedure codes (TPA-recognised codes, not just descriptions), GST line if applicable, insurance vs patient portion clearly split.
• Patient signs claim form (some TPAs still require physical; most accept digital signature).
• Patient pays the deductible + co-payment (typically 20% for most plans).
• Clinic submits claim via TPA portal (Aviva eClaims, Great Eastern OneClaim, etc.). Same day if possible.

Post-submission

• Track claim status. Most TPAs settle within 14–30 days. Anything over 30 days, follow up — usually a missing document or coding question.
• On settlement: reconcile TPA payment against claim. If TPA short-pays, identify reason and either accept (mark as write-off) or appeal.
• File the claim documents: pre-auth, signed claim form, itemised invoice, treatment notes. Retain for at least 6 years (PDPA + IRAS overlap).

Section 3 — MediSave (surgical) checklist

Eligibility check

• Procedure on MOH's MediSave-claimable list? Most surgical extractions, especially impacted wisdom teeth, qualify. Routine fillings and scaling do not.
• Patient's MediSave balance sufficient (or family member authorised to pay).
• Patient is the policyholder OR an immediate family member (parent, spouse, child, sibling).

Pre-procedure

• Submit pre-auth via the MediSave dental claim portal. Approval typically within 1–2 working days.
• Document clinical justification clearly — radiographs showing impaction, depth, position. MediSave rejects vague justifications.
• Patient signs MediSave authorisation form (digital or physical per current MOH spec).

Post-procedure

• File the claim within 14 days of treatment. Late claims may be rejected.
• Track the MediSave deduction limit. Surgical procedures have per-procedure caps (e.g. SGD 250 for simple impacted, SGD 950 for complex impacted, etc. — check current MOH schedule). Claim the lesser of cap or actual fee.
• Patient pays any portion above the MediSave cap directly.

Section 4 — CHAS subsidy checklist

• Verify patient's CHAS tier. Blue (highest subsidy), Orange (mid), Green (basic). Subsidy amount differs per tier and per procedure.
• Confirm procedure is CHAS-eligible. Routine dental — scaling and polishing, fillings, extractions — yes. Cosmetic, orthodontic, implants — no.
• Apply subsidy at point of billing. Patient pays the post-subsidy amount; clinic claims the subsidy from AIC/MOH.
• Submit CHAS claim within the monthly window.AIC settles claims monthly; late submissions roll into next cycle.
• Annual subsidy cap awareness. Each patient has an annual CHAS dental subsidy cap. Once reached, no more subsidy that year — patient pays full fee.

Section 5 — Integrated Shield Plan claims

IP riders that cover dental are less standardised. The general flow:

• Patient pays the clinic in full at discharge.
• Clinic provides itemised invoice + medical report (if required).
• Patient submits to insurer for reimbursement.
• Some clinics offer to handle this on the patient's behalf — check with the relevant insurer first; not all accept third-party submission.

Section 6 — The two-ledger principle

For every visit that's not pure self-pay, structure your records as two separate ledgers:

• Patient ledger. What the patient owes the clinic. Movements: charges, payments, refunds.
• Insurance ledger. What the insurer owes the clinic. Movements: claim submitted, claim partial-paid, claim full-paid, claim rejected.

Mixing these (one ledger, “outstanding balance”) is where reconciliation pain starts and where TPA short-pays go unnoticed. They should be separate columns in your daily accounts; only on full settlement does an entry close.

Section 7 — Pre-authorization workflow

Pre-auth saves both clinic and patient pain. Get into the discipline of always pre-authorising for:

• Any procedure > SGD 500
• Any MediSave-claimable procedure (always)
• Any procedure where the patient's coverage scope is unclear

Pre-auth playbook:

• Run pre-auth at least 24h before treatment, ideally at the point of booking.
• Document the pre-auth number in the patient record AND on the appointment.
• If pre-auth is denied, communicate to patient before the appointment, not at the chair.
• Pre-auth approval has an expiry date — typically 30–90 days. Re-authorise if treatment slips beyond the window.

Section 8 — Co-payment / deductible / co-insurance — patient explanations

Patients confuse these. Brief each at the chair using plain terms:

• Co-payment= a fixed amount the patient pays per visit (e.g. “SGD 30 each time”).
• Deductible= an amount the patient must pay before insurance kicks in (e.g. “you pay the first SGD 200 each policy year”).
• Co-insurance= a percentage of the bill the patient pays (e.g. “you pay 20%, insurance pays 80%”).

Many SG group dental plans use co-payment + co-insurance together (e.g. SGD 25 co-pay + 20% co-insurance on the balance). Brief patients clearly so the bill doesn't surprise them.

Section 9 — Weekly + monthly reconciliation

Weekly (Friday end-of-day, 30 min)

• Total clinic takings vs PMS-recorded receipts.
• Open insurance claims aging report — anything >14 days flagged.
• MediSave claims status — any rejections to investigate?
• CHAS claims pending submission for the upcoming month-end.

Monthly (last Friday of the month, 90 min)

• CHAS monthly batch submission to AIC.
• Insurance ledger close — write-off uncollectable balances after appeal.
• Patient ledger aging — patients >60 days outstanding, decision: collect / write-off / cease relationship.
• Bank reconciliation — total deposits match total clinic takings.
• Adjustment audit — every adjustment / discount / write-off in the month, reviewed and signed off.

Per-patient billing checklist (laminate at the front desk)

1. Insurance verified (TPA + scope + balance) at booking
2. Pre-auth obtained where needed; number in record
3. Patient briefed on expected out-of-pocket before chair
4. Itemised invoice with correct procedure codes
5. GST treatment correct (taxable vs exempt; see article on GST mixed-supply)
6. Insurance vs patient portion split on the invoice
7. Patient pays their portion at discharge
8. Claim submitted same day (or within 14 days for MediSave)
9. Recall scheduled and confirmed before patient leaves
10. All documents filed and retained per PDPA + IRAS retention rules

For the software side — two-ledger billing structure, automated TPA-claim submission, MediSave integration, audit-logged adjustments — Oralstack's billing module is built around this checklist. See /workflows#billing.