Category: Dental Insurance & Medicaid

Late this summer the Ohio Dental Association began receiving second-hand reports of isolated cases of dentists being "required" to accept as payment in full the allowed reimbursement amount from Blue Cross Blue Shield of Michigan even though the dentists had no contractual relationship with BCBSM. These reports also indicated the dentists were ... [continue reading]

Earlier this year a small number of Ohio Dental Association members reported receiving what they believed were incorrect payments from a handful of out-of-state Delta Dental plans. The payment amounts were significantly less than what the dentists expected them to be. Those who contacted the ODA happened to be Delta Dental Premier contracted ... [continue reading]

The ODA regularly gets calls from our member dentists seeking guidance on how to handle specific scenarios in an ethical manner. One of the most common questions we get is how to terminate the dentist-patient relationship in a proper way. Terminating the dentist-patient relationship requires the dentist to exercise care to minimize the risk of ... [continue reading]

To say the Center for Medicare and Medicaid Services (CMS) prescription drug rule has caused a lot of confusion and angst within Ohio dental practices is an understatement. Enforcement date changes, third-party payer responses to the rule and the basic premise of the rule itself have left many dentists unsure of the best action to take to address ... [continue reading]

Over the past year the Ohio Dental Association has received an increased number of calls from dentists who are the subject of some form of elevated third-party payer scrutiny relative to their use of the periodontal scaling and root planing procedure codes (D4341 and D4342). While this scrutiny goes by different names, e.g., audit, focused review, ... [continue reading]

The Ohio Dental Association continues to receive calls from Ohio dentists who are the subject of some form of elevated third-party payer scrutiny. While this scrutiny goes by different names, e.g., audit, focused review, utilization review, it typically causes a degree of angst and extra work for the involved dentist. One common area of ... [continue reading]

"How should a claim be billed when the treating dentist is not the entity that’s supposed to receive payment for the service?" The Ohio Dental Association receives that question with some degree of regularity throughout the year. The calls typically come from practices that are either bringing on an associate for the first time or are ... [continue reading]

MetLife is continuing to cause angst and frustration for dentists across the state by persisting in sending notices, in some cases three or four notices, to dentists stating “electronic funds transfer (EFT) is [MetLife’s] preferred method for provider reimbursements and this payment will be [MetLife’s] only method for provider ... [continue reading]

After three and a half years of litigation, the California Dental Association has come to a successful resolution of its legal action against Delta Dental of California. In early March, the CDA and Delta Dental jointly announced a proposed settlement concerning Delta Dental’s plans to reduce its Premier dentists’ reimbursement rates. ... [continue reading]

Over two and a half years ago a major Ohio dental insurer changed its reimbursement rate and participation obligations for newly contracted dentists. At the time, the carrier reported it made the change in order to stay competitive with other preferred provider organizations (PPOs) that were reimbursing their contracting dentists at lower rates ... [continue reading]