Category: Dental Insurance & Medicaid

SDC and the MMO SuperDental MA Network The Ohio Dental Association has received a number of calls from ODA member dentists concerning a letter they received from Superior Dental Care. The letter informed SDC contracting dentists of a material change SDC was making to its participating provider network to include them as contracted providers in ... [continue reading]

The Next Generation of the Ohio Medicaid program went live on Oct. 1. Effective Oct. 1 all provider enrollment applications must be submitted using Ohio Medicaid’s new Provider Network Management (PNM) module. The PNM module is the single point for providers to complete provider enrollment, centralized credentialing and provider ... [continue reading]

Based on dentists’ reports to the Ohio Dental Association, a small number of insurance companies and third-party administrators (TPAs) began issuing reimbursement to dentists via virtual stored value credit or debit cards instead of paper checks over a decade ago. While the number of third-party payers that use this payment methodology still ... [continue reading]

The Ohio Dental Association’s Council on Dental Care Programs and Dental Practice has identified insurance company overpayment recovery practices as one of the priority issues in need of a remedy that are adversely affecting Ohio dental practices. To set the framework for the ODA’s overpayment recovery advocacy efforts, the ODA House of ... [continue reading]

Episodes of Care The Ohio Dental Association has received numerous reports from ODA members who have received very favorable results from appealing Episodes of Care repayment amounts to the Ohio Department of Medicaid (ODM). “We are very pleased with how ODM has handled the cases of those dentists who appealed their initial, adverse ... [continue reading]

Dentists who have a negative incentive finding related to Medicaid Episodes of Care should submit a request for reconsideration by July 29, 2022. Dentists who have not already done so are strongly encouraged to “exercise their right of appeal of their Episodes of Care adverse determination” to ODM utilizing the ODM appeal form ... [continue reading]

Last month we focused on many of the issues surrounding dental insurance coverage of crowns and tips for crown claim submissions. This month we’ll extend the discussion to core buildups. Like crown claim denials, core buildup denials are one of the more common matters that Ohio Dental Association members submit to the ODA’s Dental Insurance ... [continue reading]

Earlier this year the Ohio Dental Association lodged a formal complaint with the Ohio Department of Medicaid (ODM) concerning its Episodes of Care program. ODM describes the episode-based payment program as “part of quality-driven payment innovation” that “seeks to reduce health care costs and improve quality of care by providing ... [continue reading]

Crown claim denials are one of the more common matters that Ohio Dental Association members submit to the ODA’s Dental Insurance Working Group for assistance in addressing. While each dental insurer, third-party payer and dental benefit plan sponsor can set their own unique criteria upon which to adjudicate dental claims, there are some ... [continue reading]

Receiving a clear, concise explanation of the terms of a provider contract may help you decide if participating with such a plan is best for you and your patients, as well as helping you avoid unpleasant surprises under the contract in the future. The ADA Contract Analysis Service will provide you with information concerning a proposed contract ... [continue reading]