I n s ura n ce Con nect ion
PDA/United Concordia Dental Meeting Recap
By G.L. Hamm III, DMD, Chair, Dental Benefits Committee
On February 8, I was accompanied by representatives from PDA
to meet with representatives from United Concordia Dental
(UCD). This was a follow up to our August 31, 2018 meeting. Our
intent in meeting with UCD is to establish a working relationship
so that we can professionally resolve any issue that develops.
At our August meeting, UCD told us that they are reviewing all
of their policies to determine reasonability. They advised us at the
February meeting that they completed their review and made
some changes, particularly in the area of Dental Advisor Review.
Specifically, they directed their advisors, who are practicing
dentists, to give the benefit of doubt to the submitting dentist.
This should prevent rejections, for example, of crowns following
periodontal treatment. Also, periapicals taken on the same day as
crown should no longer be denied. Further, they noted that
photographs, although not a diagnostic tool nor are they
reimbursable, are often beneficial in determining approval.
We also discussed SB1144, which is the legislation that determines
when a participating dentist can and cannot charge for non-
covered services. PDA asserts that SB1144 allows dentists to charge
their full fee when a service is totally not covered under the terms
of the patients’ contract. UCD contends that if the participating
dentist signs the non-covered service addendum to their
contract, that the dentist is held to the UCD allowance in all cases.
Therefore, there was no resolution other than to agree to
disagree. Reminder: A dentist can opt out of signing the non-
covered service addendum yet remain a participating dentist. For
more information on SB1144, see PDJ articles in the July/August
2013 and March/April 2016 issues.
I believe that the meeting was productive and that we are
establishing relationships that will result in positive outcomes in
the future.
Dental Benefits Resources
Did you know that the ADA has an entire section of its website
devoted to dental benefit issues? Check out the website at
https://success.ada.org/en/dental-benefits to learn more about
member’s top five dental benefit concerns:
1.
2.
3.
4.
5.
Provider contract issues
Coding questions
Bundling and downcoding
Coordination of benefits
EFT payments
The ADA website also has feature articles, webinars, the latest
news and tips on topics ranging from credentialing, benefits and
codes, contract negotiations, participation verses non-
participation and third party payer advocacy.
Dentists practicing at multiple locations was also addressed. This is
permissible, even to participate at one location and not participate
at another. There are certain forms to file with UCD so dentists
should contact UCD prior to establishing such arrangements.
UCD advised that fees were updated in the five county Philadelphia
area in July 2018 and in the remainder of the state in January 2019.
Finally, Utilization Review activities were discussed wherein UCD
noted that they monitor dentists who overutilize or underutilize
services and initiate contact only to those who are substantially
outside the norm.
The ADA offers a Third Party Payer Concierge who offers
assistance to members having third party payer issues in the
office. Call 800-621-8099 between 8:30 am – 5:00 pm CT.
Or email your benefit questions to dentalbenefits@ada.org and
your coding questions to dentalcode@ada.org.
JU LY/AU G U ST 2019 | P EN N SYLVAN IA DEN TAL JOURNAL
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