Category: Dental Insurance & Medicaid

Before I was ever in leadership with organized dentistry, before I was a dentist, and before I even knew what my life’s work would look like, I was part of a community – a group of individuals existing together through residential, familial and relational proximity. They were there when I was born; they were in my school and in my church. No ... [continue reading]

The number of people covered by Medicare Advantage Plans in the U.S. has increased significantly in recent years. In fact, enrollment in publicly funded dental benefit plans, namely Medicaid and Medicare Advantage Plans, represent the segments of the dental benefits marketplace that have seen the most significant growth in recent years as ... [continue reading]

Last year we provided an update on what appeared to be a relatively small trend that has been seen over the years of insurance companies and third-party administrators (TPAs) using virtual stored value cards as a means of reimbursing dentists for care they provided to covered patients. Virtual stored value cards are virtual credit or debit ... [continue reading]

Efforts by the Ohio Dental Association, Ohio Department of Medicaid (ODM), Gov. Mike DeWine, Ohio General Assembly and other advocates to increase fees paid to dentists who treat patients covered by Ohio Medicaid will soon pay off as a new Medicaid dental fee schedule is slated to take effect on Jan. 1, 2024. The fee increase will be the first of ... [continue reading]

One of the more common calls the Ohio Dental Association receives from member dentists involves the coordination of benefits (or possible issuance of refunds) for patients who are covered by multiple dental benefit plans. While the patient may benefit by having a lesser out-of-pocket expense, their multiple coverages can present administrative ... [continue reading]

The American Dental Association provides a free portal where dentists can input their credentialing information one time and provide it to third parties such as dental plans and other health care organizations. By utilizing the CAQH Provider Data Portal, dentists can enter their professional and practice information one time and submit it to ... [continue reading]

The ODA has been very active in advocating for a substantial increase in the state’s funding of Ohio’s dental Medicaid program. We have engaged state leaders for the last two years as we prepared for passage of the state’s budget for fiscal years 2024 and 2025. These efforts are paying off. The state budget that passed the Ohio General ... [continue reading]

On occasion, the Ohio Dental Association receives calls from member dentists who have seen their claims for dental services provided to a family member denied solely because the patient or subscriber is related to the dentist. The calls oftentimes involve patients or subscribers who have benefits as an employee of, or union member who works for, a ... [continue reading]

Reimbursement rates paid by preferred provider organizations (PPOs), Medicaid, managed care plans, dental health maintenance organizations (DHMOs) and other similar third-party payers are typically the primary consideration for general dentists in deciding whether to join or remain in a dental network. They can also be a major factor for ... [continue reading]

Volunteer dentists are continuing to assist Ohio Dental Association member dentists and their offices in addressing dental insurance and other third-party payer matters. They predominately serve on the ODA’s Executive Committee, Council on Dental Care Programs and Dental Practice (CDCPDP), Dental Insurance Working Group (DIWG) and Medicaid ... [continue reading]