Category: Dental Insurance & Medicaid

Over the past year the Ohio Dental Association has received an increased number of calls from dentists who are the subject of some form of elevated third-party payer scrutiny relative to their use of the periodontal scaling and root planing procedure codes (D4341 and D4342). While this scrutiny goes by different names, e.g., audit, focused review, ... [continue reading]

The Ohio Dental Association continues to receive calls from Ohio dentists who are the subject of some form of elevated third-party payer scrutiny. While this scrutiny goes by different names, e.g., audit, focused review, utilization review, it typically causes a degree of angst and extra work for the involved dentist. One common area of ... [continue reading]

"How should a claim be billed when the treating dentist is not the entity that’s supposed to receive payment for the service?" The Ohio Dental Association receives that question with some degree of regularity throughout the year. The calls typically come from practices that are either bringing on an associate for the first time or are ... [continue reading]

MetLife is continuing to cause angst and frustration for dentists across the state by persisting in sending notices, in some cases three or four notices, to dentists stating “electronic funds transfer (EFT) is [MetLife’s] preferred method for provider reimbursements and this payment will be [MetLife’s] only method for provider ... [continue reading]

After three and a half years of litigation, the California Dental Association has come to a successful resolution of its legal action against Delta Dental of California. In early March, the CDA and Delta Dental jointly announced a proposed settlement concerning Delta Dental’s plans to reduce its Premier dentists’ reimbursement rates. ... [continue reading]

Over two and a half years ago a major Ohio dental insurer changed its reimbursement rate and participation obligations for newly contracted dentists. At the time, the carrier reported it made the change in order to stay competitive with other preferred provider organizations (PPOs) that were reimbursing their contracting dentists at lower rates ... [continue reading]

Last September the American Dental Association announced its development of a new, free service to help dentists provide credentialing information to third parties. The ADA reported that the credentialing service allows dentists to input, store and update their credentials into a centralized, secure database through the ADA website, ADA.org. The ... [continue reading]

Delta Dental of Michigan, Ohio, and Indiana has tied participation in Delta Premier and/or Delta PPO to participation in its new Medicare Advantage Plan. Delta has amended its contracts with Premier and PPO participating dentists to implement this decision, and the amended contracts took effect Jan. 1, 2017. Because Delta has tied these plans ... [continue reading]

Member dentists occasionally contact the Ohio Dental Association concerning third-party reimbursement arrangements that they are unfamiliar or uncomfortable with. Common recent examples have involved unsolicited efforts by third-party payers to provide reimbursement using electronic funds transfer (EFT) or virtual credit cards. ODA advocacy and ... [continue reading]

It may be helpful for Ohio dentists to review some of the major dental benefits issues that confronted the profession during 2016 in order to prepare for the coming year. Medicare prescription drug rule The Centers for Medicare and Medicaid Services (CMS) has again delayed its enforcement of its new Medicare prescription drug rule until Jan. 1, ... [continue reading]