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170 posts found

Mar 4 2020
Should dentists receive third-party payer reimbursement for providing dental services to family members? The Ohio Dental Association and the American Dental Association say yes, but a very small number of insurance companies or dental benefit plan sponsors apparently say no. The Ohio Dental Association has again received a number of calls from ... [continue reading]
Feb 14 2020
The Ohio Department of Medicaid (ODM) recently revised its dental periodicity schedule to recommend that every Medicaid eligible child should have an oral examination at the eruption of the first primary tooth, no later than 12 months of age and semi-annual examinations thereafter. “The periodicity schedule follows professional ... [continue reading]
Feb 14 2020
Every month, volunteer member dentists who serve on the Ohio Dental Association’s Dental Insurance Working Group consider questions, concerns and complaints that are submitted by ODA member dentists relative to dental insurance. A common theme of many of the submissions involves problems associated with denied claims that could have been ... [continue reading]
Jan 16 2020
Representatives of the Ohio Dental Association and the Dental Care Plus Group (DCPG) met in mid-December to discuss recent changes that DCPG had made to its crown and core buildup claim review criteria. The changes, which went into effect on Oct. 1, 2019, caused much concern and controversy among many dentists in the Cincinnati area. DCPG is a ... [continue reading]
Dec 12 2019
The Ohio Dental Association has recently been contacted by a number of ODA members who have received a notice from an insurance company that they contract with concerning their participation/non-participation in Medicare. The notice has led many dentists to draw incorrect conclusions regarding both its intent and their options to respond to ... [continue reading]
Nov 21 2019
The Ohio Dental Association often receives questions from member dentists regarding whether they are able to receive reimbursement for services when the patient 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 changes and ... [continue reading]
Oct 17 2019
The Ohio Dental Association's Dental Insurance Working Group and ODA member dentists throughout the state have identified an apparent trend when it comes to dentists' interactions with dental insurance companies and third-party payers. Many payers don't seem willing to simply take the dentist's word on some dental insurance claims that certain ... [continue reading]
Sep 5 2019
To have a dental claim denied that the dentist believes is appropriate and necessary treatment is bad. To have a claim in the same situation disallowed or deemed not billable to the patient is horrible. Claim denials typically result from limitations or exclusions contained in the patient’s dental benefits plan, e.g., the patient has ... [continue reading]
Aug 14 2019
It appears the Ohio Dental Association has played an instrumental role in overturning a decision to terminate the participating provider status of a number of ODA member dentists with one of Ohio's Medicaid HMOs. Earlier this year numerous ODA member dentists received correspondence from DentaQuest stating that their offices would no longer be ... [continue reading]
Jul 8 2019
Ohio Dental Association members continue to address situations where an insurance company or other third-party payer wants to recover funds from reimbursement amounts they have previously made to the dentist. The causes for the initial incorrect payment, or overpayment, vary. Sometimes the initial payment was made to the dentist and other times it ... [continue reading]
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