top of page

2024 BIG Dental Changes on D0431 + Age Limits and More...

Don't you just think Dentistry is like the most consistently changing landscape in business?


Yea, me too. I've heard it said and said it a thousand times, change is the only constant. With evolving regulations, partnerships, and administrative adjustments, staying ahead of the curve is crucial for dental offices to maintain seamless operations and ensure optimal patient care.

Remote Dental outsourcing

At Dentistry Support®, we recognize the importance of proactive preparation, which is why we provide this comprehensive training to empower dental offices to navigate the complexities of billing and eligibility verifications effectively.


Why Dentistry Support® Provides This Training


Our mission at Dentistry Support® is to empower dental offices with the knowledge and resources they need to thrive in an ever-changing landscape. We understand the implications of billing errors and miscommunications, both for the practice and the patients it serves. By offering this training, we aim to equip dental teams with the tools they need to prevent errors in billing, avoid miscommunication with patients, and adapt to changes in service frequencies.

Changes are on the Horizon.


The dental industry is no stranger to change, and the recent updates from key players in the field underscore the need for vigilance and adaptability.


Let's talk the specifics of these changes and explore how they may impact your practice:


Ameritas & United Concordia Partnership:

  • Update practice management systems to reflect the partnership effective May 1, 2024.

  • Educate staff about the changes, emphasizing that insured individuals with Ameritas PPO can now see United Concordia PPO Providers.

  • Ensure fees are aligned with the "Advantage Plus Network" for billing purposes.

  • Inform patients that ID cards will reference the Ameritas Network and address any inquiries regarding the Advantage Plus Network to United Concordia at 800-307-8514.

Blue Cross & Dearborn Administrative Changes:

  • Adjust billing procedures to accommodate the downgrade in plans affecting claims processing on posterior composites.

  • Be vigilant in verifying patient eligibility and plan coverage to prevent errors in claims submission.

  • Prepare for potential refund requests for claims paid in error regarding posterior composites.

  • Update mailing addresses for Blue Cross claims submissions, particularly for claims from Oklahoma, redirecting them to P.O. Box 660247 Dallas, TX 75266.

Delta Dental Frequency Sharing:

  • Revise scheduling practices to reflect the shared frequency for Panorex and FMX procedures.

  • Update patient records to ensure accurate documentation of procedures and frequency limitations.

Mutual of Omaha Administrative Change:

  • Modify billing procedures to comply with the new processing guideline for code D4341, allowing only 2 quads on the same date instead of all 4 quads.

  • Ensure that IAPlus reflects the updated processing guideline for accurate claims submission and processing.

United Healthcare Age Limit Adjustment:

  • Review patient demographics to identify individuals affected by the raised age limit on code D0431 (age 36 & older for most fully insured plans).

  • Update patient records and billing procedures accordingly to reflect the revised age limit.

  • Verify exceptions to this guideline for ASO (self-funded) plans through IAPlus.


Now that we've highlighted the key changes impacting dental offices, let's discuss proactive steps you can take to ensure compliance and mitigate potential challenges:

  1. Stay Informed: Regularly monitor updates from dental insurance providers and regulatory bodies to stay abreast of changes affecting billing and eligibility verifications.

  2. Update Systems and Procedures: Review and update your practice management systems and billing procedures to align with the latest guidelines and requirements.

  3. Educate Your Team: Provide comprehensive training to your team members to ensure they understand the changes and their implications for daily operations.

  4. Communicate with Patients: Proactively communicate changes in coverage, fees, or service frequencies to patients to prevent misunderstandings and foster transparency.

  5. Verify Eligibility: Prior to scheduling appointments or performing procedures, verify patients' insurance eligibility and coverage details to avoid billing errors and surprises for patients.

  6. Document Thoroughly: Maintain accurate and detailed documentation of procedures, frequency limitations, and insurance information to facilitate smooth claims processing and patient communication.

  7. Seek Support: Don't hesitate to reach out to Dentistry Support® or relevant insurance providers for guidance and assistance in navigating complex billing issues or policy changes.


By taking proactive measures to adapt to these changes, dental offices can position themselves for success in a rapidly evolving landscape. Remember, staying informed, updating systems and procedures, and fostering clear communication with patients and team members are essential for ensuring compliance and delivering exceptional care.

In conclusion, while change may bring challenges, it also presents opportunities for growth and improvement. With the right knowledge, resources, and support, dental offices can navigate the shifting tides of the industry with confidence and resilience. At Dentistry Support®, we're here to empower you on your journey towards success.


 
Sarah Beth Herman

Disclaimer:


To learn more about Sarah Beth Herman, the author of all free training content you can read her bio here. These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based on your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, or insurance carrier). To the extent, Dentistry Support ®has included links to any third-party website (s), Dentistry Support ® intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support ® makes no representations or warranties about the information provided on those sites. You can view our privacy policy and terms and conditions by clicking those pages in the footer of our website.

70 views7 comments

Recent Posts

See All

7件のコメント


This topic is truly exceptional and holds immense value.

いいね!

This is so helpful! thank you!

いいね!

valerie
valerie
3月29日

a great topic to discuss especially for this year

いいね!

Very informative, love it. Thank you

いいね!

Very detailed, i like it. Thank you for this!

いいね!
bottom of page