Essential Third-Party Payer Information - Indexed For Convenience
The Third-Party Pointers articles running every month in the CDA Update newsmagazine are full of great information not only about managing third-party payer issues, but also about working the system to your benefit. Since it’s easy to miss a month or forget a crucial piece of information, here is a Third-Party Pointers index summarizing the past 12 months of topics and links to the complete articles:
July 2007 – Department of Labor assists in ERISA disputes: CDA membership pays in many ways, and having a specialist unravel vexing situations such as ERISA disputes is one of them. This article includes not only the local contacts for ERISA plans, but also the two courses of action recommended for dental practices experiencing problems with ERISA plans that chronically delay payments on claims. cda.org/library/cda_member/pubs/update0707/tpp.htm
August 2007 – Want to eliminate lost claims? Go electronic: Think a dental plan has lost your claim on purpose, and want to know how to prevent this in the future? This column is for you. cda.org/library/cda_member/pubs/update0807/tpp.htm
September 2007 – Enlisting patients as allies in payment disputes: When seeking resolution to payment disputes, patients can be a dental office’s strongest and most effective ally. After all, they may be held responsible for paying portions of treatment bills that are not paid by their dental plan. cda.org/library/cda_member/pubs/update0907/tpp.htm
October 2007 – Bedeviled by claims denials? God is in the details: No offense meant by the headline, and it says what it means. There are very specific things to do to avoid claims denials, and this article clearly spells them out.
cda.org/library/cda_member/pubs/update1007/tpp.htm
November 2007 – Let us count the ways cross coding is problematic: When are dental procedures considered to be medical procedures? When a patient’s dental benefits carrier deems them as such, apparently. It behooves dentists to know if procedures are viewed by the dental plan as the primary responsibility of patient’s medical plan.
cda.org/library/cda_member/pubs/update1107/tpp.htm
December 2007 – The best source for eligibility information may be your patients. Ever wonder what a dental office can do to increase the likelihood of receiving a reliable confirmation of patient eligibility? Check out this column.
cda.org/library/cda_member/pubs/update1207/tpp.htm
January 2008 – New coordination of benefits law effective: The thing about looking at past issues is that you have hindsight on all the things that were not obvious at the time. This is the epic column that launched a flurry of inquiries about the CDA-sponsored legislation addressing the issue of dual dental coverage and the ability of people to receive the benefit for which they or their employers have paid. cda.org/library/cda_member/pubs/update0108/tpp.htm
February 2008 – ‘Silent PPO’s’ cannot quietly avoid law: How can a dental plan that a dentist does not have a contract with claim a fee discount for a dental plan with which the dentist does have a contract? Welcome to the mysterious world of silent PPOs. Find out what’s legal and what’s not in this article. cda.org/library/cda_member/pubs/update0208/tpp.htm
March 2008 – Fielding the many questions about the coordination of benefits law: Answers to the flurry of questions that followed the January column. Covered here are such sticky wickets as continued receipt of secondary payment claims with nonduplication policies attached. cda.org/library/cda_member/pubs/update0308/tpp.htm
April 2008 – Coordination of benefits, one more time: Answers to the questions about answers to previous questions. This column covers all the nuances of the law including how dental plans could conceivably get away with citing nonduplication of benefits clauses in contracts. cda.org/library/cda_member/pubs/update0408/tpp.htm
May 2008 – Refunds of overpayments and the right of review: CDA sponsors legislation to recognize that a refund demand is “contested” not only when the dentist formally appeals the refund demand to the plan, but when it is rejected by the plan and is being appealed with either the Department of Managed Health Care or Department of Insurance. In other words, the proposed law would allow a provider to exercise full appeal rights. cda.org/library/cda_member/pubs/update0508/tpp.htm
June 2008 – The system works when you work the system: This is good stuff. If you missed this column, immediately go online, save it, print it and e-mail it to your dental friends. CDA cannot overemphasize that dentists have the right to appeal adverse payment decisions made by dental plans. Exercising your appeal rights is the surest way to reverse a contested payment decision. cda.org/library/cda_member/pubs/update0608/tpp.htm