Category: Dental Insurance & Medicaid

One of the more common calls the Ohio Dental Association receives from member dentists involves the coordination of benefits (or possible issuance of refunds) for patients who are covered by multiple dental benefit plans. While the patient may benefit by having a lesser out-of-pocket expense, their multiple coverages can present administrative ... [continue reading]

The American Dental Association provides a free portal where dentists can input their credentialing information one time and provide it to third parties such as dental plans and other health care organizations. By utilizing the CAQH Provider Data Portal, dentists can enter their professional and practice information one time and submit it to ... [continue reading]

The ODA has been very active in advocating for a substantial increase in the state’s funding of Ohio’s dental Medicaid program. We have engaged state leaders for the last two years as we prepared for passage of the state’s budget for fiscal years 2024 and 2025. These efforts are paying off. The state budget that passed the Ohio General ... [continue reading]

On occasion, the Ohio Dental Association receives calls from member dentists who have seen their claims for dental services provided to a family member denied solely because the patient or subscriber is related to the dentist. The calls oftentimes involve patients or subscribers who have benefits as an employee of, or union member who works for, a ... [continue reading]

Reimbursement rates paid by preferred provider organizations (PPOs), Medicaid, managed care plans, dental health maintenance organizations (DHMOs) and other similar third-party payers are typically the primary consideration for general dentists in deciding whether to join or remain in a dental network. They can also be a major factor for ... [continue reading]

Volunteer dentists are continuing to assist Ohio Dental Association member dentists and their offices in addressing dental insurance and other third-party payer matters. They predominately serve on the ODA’s Executive Committee, Council on Dental Care Programs and Dental Practice (CDCPDP), Dental Insurance Working Group (DIWG) and Medicaid ... [continue reading]

Dealing with the subject of fees can be a sensitive issue but at the same time a necessary part of the patient-dentist relationship. The subject can become exponentially more difficult when an insurance company or other third-party payer becomes involved in the discussion. One of the most antagonizing things a dentist can encounter involves an ... [continue reading]

The state’s proposed budget for fiscal years 2024 and 2025 was introduced on Feb. 15, 2023, in the form of House Bill 33. In preparation of the budget, the ODA has been advocating with policymakers and state leaders for a significant increase in dental Medicaid reimbursements for the last year. Throughout the last half of February and the entire ... [continue reading]

The Ohio Dental Association often receives questions from member dentists regarding whether they are able to receive reimbursement for services when one of their patients does not complete the prescribed course of treatment, e.g., a tooth has been prepped but for whatever reason the crown does not get seated. Patient non-compliance, benefit plan ... [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]