We understand the challenges that come with navigating third-party payers and insurance relationships. As a benefit of your membership, the ODA provides opportunities to help get the support you need.
ODA Staff Assistance
Contact Us DirectlyOur ODA staff is available to answer questions about dental insurance and third-party payer information as a benefit of your membership. To utilize this service, call the ODA at (800) 282-1526 or email dentist@oda.org.
Our ODA staff is available to answer questions about dental insurance and third-party payer information as a benefit of your membership. To utilize this service, call the ODA at (800) 282-1526 or email dentist@oda.org.
ODA DENTAL INSURANCE WORKING GROUP (DIWG)
How to Submit an Issue to DIWG
If you have been unsuccessful in resolving a third-party payer situation on your own, consider submitting your issue to the DIWG via our confidential and secure online form below.
- Include all supporting documentation that will help the working group understand the situation. Documentation should include everything that was submitted to the insurance company and the response(s), such as a description of the situation, copy of the submitted claim form and claim denial with the explanation of benefits, copy of any appeal, photographs, radiographs, charting, etc. .
- Remember to redact all information that would identify any specific patients.
If you prefer to submit your insurance issue via mail, fax or email, please send all documentation to: ODA Dental Insurance Working Group 1370 Dublin Rd., Columbus, Ohio 43215 or via fax at (614) 486-0381 or via email to chrism@oda.org
The DIWG is comprised of a dedicated group of ODA member dentists who volunteer their time to determine the ODA’s formal role in addressing dental insurance-related questions, concerns and complaints involving dental insurance and third-party payers that are submitted by ODA member dentists.
This working group meets the second Tuesday of every month via conference call to address dental insurance questions, concerns, complaints, etc. that are submitted by ODA member dentists
DIWG members also serve on the Council on Dental Care Programs and Dental Practice, and their services are only available to ODA member dentists.
Learn more about the Dental Insurance Working Group.
If you have been unsuccessful in resolving a third-party payer situation, you may want to consider submitting information to the Dental Insurance Working Group to determine if the ODA has a role in addressing the matter.
The working group has served for many years as an advocate and counselor to ODA members who have encountered problems with third-party payers.
- The DIWG will review the information you have provided to ensure they have a deep understanding of the issue.
- ODA staff or a working-group member may reach out to you to get additional information or answers to questions.
- The group then determines the ODA’s role in best assisting you, including contacting the dental insurance company on your behalf when appropriate.
- When appropriate, the DIWG will provide you with documentation of the ODA’s efforts you can use to add credibility to your position with the patient involved.
- Denials or limitations for certain services (such as core buildups, crowns, endodontic therapy, scaling and root planning and radiographs).
- Payment of non-contracting dentists.
- Applications of participating provider agreements.
- Application of least expensive alternative benefit clauses.
- Participating provider listings.
- Focused review, utilization review and other types of audits.
- Dentist rating systems.
- Overpayment recovery.
- CDT dental code usage.
- Unfair cuts to fee schedules.
Insurance Contract Analysis Service
The ODA also provides dentists with an Insurance Contract Analysis service to help you get a clear, concise explanation of the terms of a provider plan and contract before you decide to participate. This complimentary service is an exclusive ODA member benefit.
Insurance Education Presentations
ODA representatives present dental insurance seminars at ODA, local dental society, and dental school functions throughout the year. To schedule a free seminar, a dental society or dental school just needs to contact the ODA to reserve one.
Dental Insurance Resources
The American Dental Association has created valuable information on dental insurance. Additional resources created by the ADA to assist member dentists include:
- The ADA credentialing service, powered by CAQH ProView®, helps dentists share credentialing information with multiple dental plans quickly and easily.
- Online videos and tutorials to assist dentists and new and experienced staff to better understand a wide range of dental insurance issues including: Medicare Advantage (Part C) Plans, the basics of PPOs, trends in dental insurance, self-funded dental plans, bringing in a temporary dentist to the practice and common dental benefits issue questions.
- Commonly asked dental insurance questions and answers.
- Resources for understanding, negotiating with and working with PPOs including dealing with PPO processing policies and audits.
- Information on improving dental claims success and addressing problem claims.
- Information on electronic claims.
- Legislative advocacy on dental insurance fees, antitrust exemption and policy reforms.
- Resources on properly utilizing the CDT code and making revisions to the code.
Dental Insurance CornerThe “Dental Insurance Corner” is published monthly in the “ODA Today” to answer frequent questions and help members with common third-party payer issues. The ADA also features numerous resources including webinars, publications, guides, and more.
The “Dental Insurance Corner” is published monthly in the “ODA Today” to answer frequent questions and help members with common third-party payer issues. The ADA also features numerous resources including webinars, publications, guides, and more.
