Category: Dental Insurance & Medicaid

Episodes of Care The Ohio Dental Association has received numerous reports from ODA members who have received very favorable results from appealing Episodes of Care repayment amounts to the Ohio Department of Medicaid (ODM). “We are very pleased with how ODM has handled the cases of those dentists who appealed their initial, adverse ... [continue reading]

Dentists who have a negative incentive finding related to Medicaid Episodes of Care should submit a request for reconsideration by July 29, 2022. Dentists who have not already done so are strongly encouraged to “exercise their right of appeal of their Episodes of Care adverse determination” to ODM utilizing the ODM appeal form ... [continue reading]

Last month we focused on many of the issues surrounding dental insurance coverage of crowns and tips for crown claim submissions. This month we’ll extend the discussion to core buildups. Like crown claim denials, core buildup denials are one of the more common matters that Ohio Dental Association members submit to the ODA’s Dental Insurance ... [continue reading]

Earlier this year the Ohio Dental Association lodged a formal complaint with the Ohio Department of Medicaid (ODM) concerning its Episodes of Care program. ODM describes the episode-based payment program as “part of quality-driven payment innovation” that “seeks to reduce health care costs and improve quality of care by providing ... [continue reading]

Crown claim denials are one of the more common matters that Ohio Dental Association members submit to the ODA’s Dental Insurance Working Group for assistance in addressing. While each dental insurer, third-party payer and dental benefit plan sponsor can set their own unique criteria upon which to adjudicate dental claims, there are some ... [continue reading]

Receiving a clear, concise explanation of the terms of a provider contract may help you decide if participating with such a plan is best for you and your patients, as well as helping you avoid unpleasant surprises under the contract in the future. The ADA Contract Analysis Service will provide you with information concerning a proposed contract ... [continue reading]

Episodes of Care Earlier this year the Ohio Dental Association filed a formal complaint with the Ohio Department of Medicaid (ODM) concerning determinations made through ODM’s Episodes of Care payment program that many dentists had to return money for care provided to patients covered by Ohio Medicaid. Some dentists had been asked to return, ... [continue reading]

The Ohio Dental Association has lodged a formal complaint with the Ohio Department of Medicaid (ODM) concerning its Episodes of Care program. In a letter to Medicaid Director Maureen Corcoran, Dr. Thomas Kelly, ODA president, and Dr. Jennifer Kale, chair of the ODA Council on Access to Care and Public Service and ODA Medicaid Working Group, ... [continue reading]

The Ohio Dental Association has lodged a formal complaint with the Ohio Department of Medicaid (ODM) concerning its Episodes of Care program. Click here to view the letter. The ODA Medicaid Working Group strongly suggests that any dentist who has been notified that they must return money either directly to the state of Ohio or to one of the ... [continue reading]

The Centers for Medicare & Medicaid Services (CMS) recently clarified its rules prohibiting payment to providers, including dentists, who have formally opted out of participation in Medicare to not apply to supplemental benefits like dental benefits. This means that dental services provided by dentists who have opted out of Medicare may now be ... [continue reading]