Category: Dental Insurance & Medicaid

If you have been unsuccessful in resolving a third-party payer situation, you may want to consider submitting information to the Ohio Dental Association’s Dental Insurance Working Group (DIWG) to determine if the ODA has a role in addressing the matter. The DIWG is comprised of a dedicated group of ODA member dentists who volunteer their time ... [continue reading]

By the end of June, the Ohio General Assembly will pass, and Governor Mike DeWine will sign into law, a budget for the state of Ohio covering state fiscal years 2024 and 2025. In anticipation, the ODA has been educating policymakers for the last year about the need for substantial increases in funding for Ohio’s dental Medicaid program. My ... [continue reading]

Medicare and Medicare Advantage Plans The number of people covered by Medicare Advantage Plans 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 significant growth in ... [continue reading]

Multiple procedure reduction pricing on fee-for-service dental claims The Ohio Department of Medicaid (ODM) is responding favorably to a claims processing policy change that had begun to negatively impact Ohio dentists in a very significant way after being contacted by the Ohio Dental Association. The situation involves claims for multiple ... [continue reading]

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]

The Ohio Department of Medicaid (ODM) is asking all dental providers enrolled in Medicaid to complete a survey regarding the services they provide to Medicaid members. The purpose of the survey is for ODM to ensure that adequate dental coverage exists for Medicaid members. To take the survey, visit ... [continue reading]

On Feb. 1, 2023, Ohio Medicaid’s seven Next Generation managed care plans will begin serving members. At the same time, ODM’s new Electronic Data Interchange (EDI) and the Fiscal Intermediary (FI) will go live. For more details about the launch, including training resources for providers, visit ... [continue reading]

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]