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ADA is Asking for HELP with Third-Party Payers for Dentists

Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

With these unprecedented and extraordinary circumstances, dentists are facing new challenges with reimbursement with what is allowed and covered under their contractual obligations with their payers. The ADA recognizes the struggles dental providers are facing and is urging third-party payers to adopt new reimbursement procedures and adjust their fee schedules to help their patients during the pandemic.

The American Dental Association sent a letter to third-party payer administrators asking them to adopt several vital changes, particularly due to the significant impact of COVID-19 regarding coding and billing.

Due to physical distancing, payers are urged not to bundle fees for temporary services with the payment for a permanent procedure that may be required and submitted in the future.

The ADA advocacy also addresses other areas such as out-of-network benefits, frequency limitations, telecommunication technology, point-of-care COVID testing, and infection control expenditures. The ADA is urging payers to consider these particular circumstances when reviewing fee contracts and take into consideration the additional infection control standards and costs required to treat patients.

With telecommunication being a vital part of supporting patients, payers are encouraged to consider additional benefits using telecommunication to provide triage and evaluations as needed. Out of network benefits are encouraged to provide treatment to patients when their primary dental care site is closed, urging payers to pay providers as if they were in-network.

The ADA is asking payers to consider removing arbitrary limiting frequency limitations on periodontal maintenance and topical fluoride and sealants, as patients may not be receiving the required preventative care, which may impact a progressive disease as a consequence.

Dental providers must provide testing for COVID-19. Therefore, the ADA is asking payers to consider any coverage issues they may have to begin any such related issues with benefits and on-site testing by dentists.