Category: Dental Insurance & Medicaid

In 2023, the Ohio General Assembly will consider and pass the state budget for fiscal years 2024 and 2025. The ODA’s biggest priority for the next state budget will be to significantly increase funding for the state’s dental Medicaid program. The ODA has already begun the process of educating policymakers on the importance of fully funding ... [continue reading]

The federal No Surprises Act and Ohio’s surprise billing law have been in effect for a little over a year. While it appears there may be some limited confusion about the laws and their application to the average dentist, it also appears that this confusion has not resulted in Ohio dentists incurring substantive negative consequences from either ... [continue reading]

Question: Can a dentist who is not under contract to an insurance company be forced to accept the insurer’s allowed fee solely because the dentist accepted assignment of benefits from the patient? Answer: Providing nothing else is going on, no. Just as a patient/subscriber and a dentist cannot obligate an insurance company or other ... [continue reading]

The Next Generation of the Ohio Medicaid program went live on Oct. 1. Effective Oct. 1 all provider enrollment applications must be submitted using Ohio Medicaid’s new Provider Network Management (PNM) module. The PNM module is the single point for providers to complete provider enrollment, centralized credentialing and provider ... [continue reading]

SDC and the MMO SuperDental MA Network The Ohio Dental Association has received a number of calls from ODA member dentists concerning a letter they received from Superior Dental Care. The letter informed SDC contracting dentists of a material change SDC was making to its participating provider network to include them as contracted providers in ... [continue reading]

The Next Generation of the Ohio Medicaid program went live on Oct. 1. Effective Oct. 1 all provider enrollment applications must be submitted using Ohio Medicaid’s new Provider Network Management (PNM) module. The PNM module is the single point for providers to complete provider enrollment, centralized credentialing and provider ... [continue reading]

Based on dentists’ reports to the Ohio Dental Association, a small number of insurance companies and third-party administrators (TPAs) began issuing reimbursement to dentists via virtual stored value credit or debit cards instead of paper checks over a decade ago. While the number of third-party payers that use this payment methodology still ... [continue reading]

The Ohio Dental Association’s Council on Dental Care Programs and Dental Practice has identified insurance company overpayment recovery practices as one of the priority issues in need of a remedy that are adversely affecting Ohio dental practices. To set the framework for the ODA’s overpayment recovery advocacy efforts, the ODA House of ... [continue reading]

Episodes of Care The Ohio Dental Association has received numerous reports from ODA members who have received very favorable results from appealing Episodes of Care repayment amounts to the Ohio Department of Medicaid (ODM). “We are very pleased with how ODM has handled the cases of those dentists who appealed their initial, adverse ... [continue reading]

Dentists who have a negative incentive finding related to Medicaid Episodes of Care should submit a request for reconsideration by July 29, 2022. Dentists who have not already done so are strongly encouraged to “exercise their right of appeal of their Episodes of Care adverse determination” to ODM utilizing the ODM appeal form ... [continue reading]