Crown claim denials are one of the more common matters that Ohio Dental Association members submit to the ODA’s Dental Insurance Working Group for assistance in addressing. While each dental insurer, third-party payer and dental benefit plan sponsor can set their own unique criteria upon which to adjudicate dental claims, there are some ... [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]
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]
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]
The Ohio Dental Association has lodged a formal complaint with the Ohio Department of Medicaid (ODM) concerning its Episodes of Care program. Click here to view the letter. The ODA Medicaid Working Group strongly suggests that any dentist who has been notified that they must return money either directly to the state of Ohio or to one of the ... [continue reading]
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]
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]
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]
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 firstname.lastname@example.org by January 14, 2022.
Dentists may also ... [continue reading]
The Ohio Department of Medicaid reports that its next generation managed care program will go live July 1, 2022. In preparation for the next generation program, providers should contact the next generation managed care entities (MCE) that they are interested in contracting with to begin the process to join their provider networks. Provider ... [continue reading]
The views expressed in the articles and columns on oda.org are solely those of the author(s) and do not necessarily represent the view of the Ohio Dental Association (ODA). The columns are intended to offer opinions, information and general guidance and should not be construed as legal advice or as an endorsement by the ODA. Further, information posted on oda.org is not an endorsement by the ODA and should be viewed on an informational basis by users of the website. Dentists should always seek the advice of their own legal counsel regarding specific circumstances.
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Membership in the Ohio Dental Association has many benefits designed not only to help dentists in their daily practice, but also to further the development of the dental profession.
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