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May 4 2022
Receiving a clear, concise explanation of the terms of a provider contract may help you decide if participating with such a plan is best for you and your patients, as well as helping you avoid unpleasant surprises under the contract in the future. The ADA Contract Analysis Service will provide you with information concerning a proposed contract ... [continue reading]
May 4 2022
Episodes of Care Earlier this year the Ohio Dental Association filed a formal complaint with the Ohio Department of Medicaid (ODM) concerning determinations made through ODM’s Episodes of Care payment program that many dentists had to return money for care provided to patients covered by Ohio Medicaid. Some dentists had been asked to return, ... [continue reading]
Apr 11 2022
The Ohio Dental Association has lodged a formal complaint with the Ohio Department of Medicaid (ODM) concerning its Episodes of Care program. In a letter to Medicaid Director Maureen Corcoran, Dr. Thomas Kelly, ODA president, and Dr. Jennifer Kale, chair of the ODA Council on Access to Care and Public Service and ODA Medicaid Working Group, ... [continue reading]
Mar 3 2022
The Centers for Medicare & Medicaid Services (CMS) recently clarified its rules prohibiting payment to providers, including dentists, who have formally opted out of participation in Medicare to not apply to supplemental benefits like dental benefits. This means that dental services provided by dentists who have opted out of Medicare may now be ... [continue reading]
Feb 15 2022
Reports from the American Dental Association (ADA) and the Centers for Medicare and Medicaid Services (CMS) indicate a new federal law that took effect at the beginning of 2022 will very likely have an impact on most dental offices in Ohio and across the nation. The No Surprises Act is intended to provide consumers with new billing protections ... [continue reading]
Jan 11 2022
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]
Jan 11 2022
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]
Dec 14 2021
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]
Nov 9 2021
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]
Oct 19 2021
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]
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