While there is a clear trend for dentists to join into participating provider agreements with managed care plans now more than ever, the Ohio Dental Association has received a marked increase in the number of member dentists inquiring about how to terminate their contracts with networks they participate in. Some of the callers were just starting ... [continue reading]
Over the years the number of calls to the Ohio Dental Association concerning prompt pay issues have dropped dramatically. Dentists’ adoption of electronic claims submission technology and insurance companies’ utilization of automatic claims processing practices have significantly helped with the timely adjudication of many claims. Slow ... [continue reading]
The Ohio Dental Association has presented a written request to Delta Dental of Michigan, Ohio, and Indiana that calls for Delta Dental to take immediate steps to address its reimbursement rates by 1) increasing dental reimbursement rates and 2) incorporating an annual cost of living increase to its reimbursement practices. The letter is a ... [continue reading]
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]
Every month, a dedicated group of Ohio Dental Association member dentists volunteer their time to serve during conference call meetings of the ODA Dental Insurance Working Group (DIWG). They address the wide variety of dental insurance related questions, concerns and complaints that are submitted by ODA member dentists seeking help on matters they ... [continue reading]
In early April the Ohio Department of Medicaid (ODM) announced which insurance companies it has preliminarily selected to administer the $20 billion managed care or Medicaid HMO portion of Ohio’s Medicaid program. They are AmeriHealth Caritas Ohio, Inc.; Anthem Blue Cross and Blue Shield; CareSource Ohio, Inc.; Humana Health Plan of Ohio, ... [continue reading]
Within the last two years, DentaQuest has garnered a lot of attention from Ohio dentists as it began administering the dental component of CareSource’s Medicaid HMO product and through its acquisition of the private insurance company Dental Care Plus Group (DCPG). Representatives of the Ohio Dental Association, through the ODA Medicaid ... [continue reading]
When it comes to managed care contracting issues, one of the more common calls the Ohio Dental Association receives involve leased dental networks. Callers’ questions typically are something like: How can I be bound to a plan’s fee limits when I never signed a contract with that plan? Can I stay in the network but opt out of one or two ... [continue reading]
The Ohio Dental Association Council on Dental Care Programs and Dental Practice continues to monitor and address third-party payer issues on the ODA membership’s behalf. One issue of particular note that the council has been monitoring involves silent discount arrangements that are commonly known as “silent PPOs,” “ghost PPOs” or ... [continue reading]
Effective May 1, 2020, CareSource transitioned the administration of the dental component of its Medicaid HMO product to DentaQuest. A number of issues have emerged as a result of this transition. Representatives of DentaQuest and the Ohio Dental Association, through the ODA Medicaid Working Group, have been working together to identify and then ... [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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