Dentists who sign participating provider agreements with preferred provider organizations (PPOs) and other contracting organizations acknowledge they must know and comply with terms of those agreements. A case recently submitted to the Ohio Dental Association's Dental Insurance Working (DIWG) illustrates the need for dentists to be aware of the ... [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). These dentists determine the ODA’s role in addressing dental insurance related questions, concerns and complaints involving third-party payers that are ... [continue reading]
A number of Ohio Dental Association members have contacted the ODA over the past year regarding their concerns with how Delta Dental of Michigan, Ohio, and Indiana (Delta Dental) has processed their periodontal scaling and root planing claims. The complaints have typically involved a claim disallowance, which means the claim is denied and the ... [continue reading]
Many Ohio Dental Association members have contacted the ODA concerning a February letter they received from WILMAPC, the state of Ohio's Workplace Injury Labor Management Approved Provider Committee. The letter congratulated the dentists on being selected to be part of “a select group of providers committed to ensuring that State Agency ... [continue reading]
There is no way a dentist can prevent a third-party payer from auditing or "red flagging" his/her claims. A dentist’s actions, however, can impact the likelihood of unwanted insurance company scrutiny.
For example, providing significantly more crowns or core buildups or doing more than two quadrants of scaling and root planing on the same ... [continue reading]
Every month the Ohio Dental Association receives calls from member dentists concerning how to properly coordinate benefits (or issue refunds) for patients who are fortunate enough to be covered by multiple dental benefit plans. While the patient may benefit by having a lesser out-of-pocket expense, their multiple coverages can present ... [continue reading]
Like almost everything else associated with Medicare’s prescription drug rule, the most recent actions by the Centers for Medicare and Medicaid Services (CMS) have sparked a flurry of calls to the Ohio Dental Association from member dentists.
Late last year, CMS announced its plans to rescind certain Medicare Part C and D requirements for ... [continue reading]
The Ohio Dental Association at times receives calls from member dentists concerned about insurance company claim denials because the carrier determined the work the dentist provided was not medically necessary. If appealing the denial does not provide a satisfactory resolution to the matter, then the dentist and patient may want to consider ... [continue reading]
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 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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