Category: Dental Insurance & Medicaid

Happy March! I am excited about seeing everyone at Leadership Institute March 21-22! If you haven’t registered yet go to https://www.oda.org/events-ce/leadership-institute. In this month’s column I would like to share some thoughts about Medicaid. Here are a few statistics to chew on as we go along: The population of Ohio is 11.8 ... [continue reading]

The Ohio Dental Association is often contacted by ODA member dentists upset with how an insurance company or other third-party payer has handled a dental claim. Some of these calls involve claim or prior authorization denials issued by a Medicaid HMO because the insurer determined the service in question was not medically necessary. As more ... [continue reading]

The Ohio Dental Association and LIBERTY Dental Plan have successfully worked together to develop practical plan criteria and medical necessity guidelines that dentists and LIBERTY can use to demonstrate the actual placement of a crown during the claim submission process for LIBERTY’s Medicare Advantage Plan. LIBERTY reported that it has ... [continue reading]

If you have been unsuccessful in resolving a dental insurance or third-party payer situation, you may want to consider submitting information to the Ohio Dental Association’s Dental Insurance Working Group (DIWG) to determine if the ODA has a role in addressing the matter. The DIWG is comprised of a dedicated group of ODA member dentists who ... [continue reading]

The Ohio Dental Association has received many calls over the last number of months concerning Ohio’s new non-covered services law. It may be helpful to review the new law and the commonly asked questions concerning it so dental offices have a good idea of what to expect from its full implementation on Jan. 1, 2025. Background and key to ... [continue reading]

One of the more common calls to the Ohio Dental Association involves the proper way to report dental insurance claims when the treating dentist is different from the billing entity or billing dentist. Most of the calls were prompted by a dental practice bringing on an associate for the first time though some involve dentists who are going on ... [continue reading]

A new report from the American Dental Association’s Health Policy Institute shows the dramatic improvement state policymakers have made to the Ohio dental Medicaid program. Ohio’s dental Medicaid reimbursements have gone from near the bottom in the country to near the top as a result of a significant increase in funding starting earlier this ... [continue reading]

It has been estimated that synthetic identity fraud, the creation of new identities with stolen or fabricated data, is the fastest-growing financial crime in the United States. In fact, the U.S. Department of Justice, Bureau of Justice Statistics has reported “in 2021, about 23.9 million U.S. residents age 16 or older (9% of the population) had ... [continue reading]

The Ohio Department of Medicaid has responded to the Ohio Dental Association’s formal request for ODM to standardize the administration of state’s Medicaid dental benefit program across the fee-for-service and managed care programs. The ODA’s request was prompted by ongoing concerns many ODA members have expressed with how DentaQuest ... [continue reading]

On July 24, 2024, Gov. Mike DeWine signed Senate Bill 40, which contained language that would eliminate the requirement for dentists to accept a fee schedule for services that the insurance companies do not even cover. This was the result of many years of advocacy from the ODA on the topic. But now that it has passed what does this mean for dental ... [continue reading]