No need to face third-party payers on your own
September 12, 2018
When Dr. Ron Riggins received a notice via mail earlier this year from a third-party payer that it was only going to send electronic funds transfer payments and no longer sending paper checks, he knew something was off.
"I had remembered from a previous article in the ADA News that this was not standard practice," said Dr. Riggins, a general dentist from Moline, Illinois.
Dr. Riggins said he immediately contacted the ADA Third Party Payer Concierge, an exclusive member perk that connects dentists with ADA staff from the Center for Dental Benefits, Coding and Quality to help resolve dental benefit issues.
"The Third Party Payer Concierge gathered all the information from my staff and began to solve the problem," Dr. Riggins said. "Within a few weeks the ADA had reached out to the third-party payer and clarified the situation. The ADA then used its resources to inform members of the issue."
Provider issues remain among the top concerns for dentists, according to ADA surveys. Members have expressed frustration and confusion when it comes to denied claims, low reimbursements and dealing with third-party payer portals and processing policies.
"Issues with third-party payers, whether it is intrusive processing policies, medical necessity rules or explanation of benefits language, affect most dentists every single day," said Dr. Steven Snyder, Council on Dental Benefit Programs chair. "For members, the ADA offers this concierge service with experts a phone call away to support and help you in navigating this environment."
Recently, the ADA staff has helped members with third-party payer issues in:
- Providing guidance in the appeals process when a claim has been denied.
- Contacting dental plans to revise explanation of benefits language that impugned on the dentist-patient relationship.
- Connecting individual dentists with a dental plan's consulting dentist.
- Clarifying requirements on electronic fund transfer payments.
"The ADA staff is always extremely helpful when calling with questions or concerns," Dr. Riggins said. "The Third Party Payer Concierge is a real person who picks up the phone. Since third-party issues are one of the top concerns of dentists and dental offices, the service is a huge member benefit that hopefully more dentists will utilize."
The ADA can help dentists with dental benefits-related and coding problems, questions and concerns. Call the ADA's Third Party Payer Concierge at 1-800-621-8099 or email email@example.com. Additional dental benefit resources can be found at ADA.org/dentalbenefits.
Members can also fill out an online third-party complaint form at Success.ADA.org/en/dental-benefits/online-third-party-form.