The American Dental Association is supporting dentists dealing with claim downcoding by third-party insurers.
Five notes:
1. The ADA said Oct. 7 that it will support states and dental providers addressing downcoding in response to increased reports of the practice.
2. The ADA’s stance aligns with a policy the agency adopted in 2016 opposing claims payment abuse.
3. The ADA said it has recently taken action to support dentists facing reimbursement challenges, including contacting the Delta Dental Plans Association after a dentist experienced downcoding for tooth restorations. The ADA was told by the insurance company that claims issues must be resolved with individual Delta Dental member companies.
4. The ADA Council on Dental Benefit Programs urged state dental associations and dentists to raise concerns about reimbursements directly with their local Delta Dental member companies to help ensure fair claims processing.
5. The ADA also recommended providers continue to appeal payer decisions that involve downcoding.
