Category: Dental Insurance & Medicaid

The Ohio Dental Association Council on Dental Care Programs and Dental Practice monitors and addresses third-party payer issues on the profession's behalf. One issue of particular note that the council has been monitoring involves silent preferred provider organizations (PPOs). In its 2010 Silent PPO White Paper, the American Association of ... [continue reading]

The state's largest dental benefits program, Ohio Medicaid, is implementing new rules effective Jan. 1, 2016. The wide-ranging rules impact coverage and payment policies for dental services and related oral health services. More than 2.6 million Ohioans are covered by Medicaid, the state and federally funded health insurance program that covers ... [continue reading]

With the end of the year fast approaching, dentists should ensure their practice has acted on two third-party payer related issues before the New Year rings in. One, the “Current Dental Terminology” (CDT), is very straight forward, but the other, Medicare, is not as straight forward and has been wrapped in confusion for many. CDT 2016 now ... [continue reading]

More than 2.6 million Ohioans are covered by Medicaid, the state and federally funded health insurance program that covers low-income adults, children, pregnant women, senior citizens and individuals with disabilities. About 70 percent of those covered are enrolled in Medicaid’s managed care program, and the remainder are in its ... [continue reading]

Another third-party payer has been identified as paying dentists with a modality that many dentists find objectionable. It involves a nationwide insurance company that the American Dental Association has identified as requiring contracting dentists to choose between electronic funds transfer (EFT) and virtual credit cards as their preferred ... [continue reading]

Whenever the talk goes to insurance fraud people invariably think of the dentist as the perpetrator of the offense. Dentists themselves often think the same way and many times fail to recognize that fraudulent activity does not have to be limited to the practitioner and many times involves dental office staff and/or patients. A quick glance at ... [continue reading]

The Ohio Dental Association has received numerous complaints from ODA member dentists in northeastern Ohio regarding a Canton-based Medicare Advantage Plan's (MA Plan) 2 percent withhold or payment reduction. The reduction is explained on the MA Plan’s explanation of benefits (EOB) as a “Withhold Amount Sequestration – reduction ... [continue reading]

Is there a difference between an inlay and an onlay? Yes, there is and the difference is both in terms of clinical practice and benefits determinations. While the answer may seem obvious, the Ohio Dental Association continues to receive reports from third-party payers that some dentists may not fully appreciate the differences when submitting ... [continue reading]

As more dentists submit dental benefits claims electronically to third-party payers, the Ohio Dental Association has seen a marked decrease in the number of calls involving slow pay situations. The calls the ODA does receive now typically concern how much time an insurance company has to pay a claim. Ohio does have a law governing insurance plan ... [continue reading]

The Ohio Dental Association is again receiving calls from dentists upset about the discounts they're being asked to give certain patients. A common theme among the callers is that the dentist has been directed to discount his/her fees for patients of plans the dentist has not signed a contract with. How can this be? What’s the payer’s ... [continue reading]