Category: Dental Insurance & Medicaid

The November and December Dental Insurance Corners discussed a letter that was recently sent from a major dental insurer to numerous Ohio dentists concerning their practices’ utilization patterns, how utilization review works and what dentists can do to minimize their risks with respect to third-party payer reviews and audits. There are steps ... [continue reading]

The ADA Council on Dental Benefits Programs is proceeding with a new project to review and enhance the Code on Dental Procedures and Nomenclature (CDT Code). As part of the project, the Enhanced CDT Taskforce is seeking comment from dentists. Dentists can provide feedback via email to dentalcode@ada.org by January 14, 2022. Dentists may also ... [continue reading]

The Ohio Department of Medicaid reports that its next generation managed care program will go live July 1, 2022. In preparation for the next generation program, providers should contact the next generation managed care entities (MCE) that they are interested in contracting with to begin the process to join their provider networks. Provider ... [continue reading]

Last month’s Dental Insurance Corner discussed a letter that was recently sent from a major dental insurer to numerous Ohio dentists concerning their practices’ utilization patterns. Insurance companies utilize auto-adjudication to process more claims than ever. Auto-adjudication is the automated process of paying or denying claims quickly ... [continue reading]

A letter recently sent from a major dental insurer to numerous Ohio dentists concerning their practices’ utilization patterns has prompted calls and questions to the Ohio Dental Association. The callers expressed confusion and concern about the letter and questioned what it really meant to their practices and what actions they should take in ... [continue reading]

The Ohio Dental Association has written Cigna Dental to express its concerns with a recent decision by Cigna to substantially reduce network dentists’ reimbursement. The ODA’s action is in response to a number of ODA member dentists who contacted the ODA after receiving a letter from Cigna Dental that it would begin utilizing a new fee ... [continue reading]

While there is a clear trend for dentists to join into participating provider agreements with managed care plans now more than ever, the Ohio Dental Association has received a marked increase in the number of member dentists inquiring about how to terminate their contracts with networks they participate in. Some of the callers were just starting ... [continue reading]

Over the years the number of calls to the Ohio Dental Association concerning prompt pay issues have dropped dramatically. Dentists’ adoption of electronic claims submission technology and insurance companies’ utilization of automatic claims processing practices have significantly helped with the timely adjudication of many claims. Slow ... [continue reading]

One of the busiest times of the year has come and gone in the Ohio legislature. The biennial operating budget (House Bill 110) has passed the House and Senate and has been signed by the governor. The budget has to be passed by July 1 in order for the state to continue to operate. The main purpose of the budget is to allocate money to departments ... [continue reading]

On May 19, 2021, Ohio Medicaid vendor Maximus learned of a cybersecurity incident involving an application related to Medicaid providers’ credentialing and licensing data in Ohio, according to the Ohio Department of Medicaid. The incident potentially impacted some personal information about Medicaid providers (such as names, dates of birth, ... [continue reading]