The American Dental Association defines downcoding as a “third-party payer claim adjudication process that uses a procedure code that is different from the one reported on the claim so that the reimbursement amount is less than would be allowed for the submitted code.” Louisiana Act 187 bans third-party payers from downcoding a fixed bridge to a removable bridge and requires them to disclose their benefits notices and routine downcoding policies.
Louisiana Act 256 allows dental providers to require patients with preexisting conditions undergo a 12-month waiting period for coverage, but bans them from denying it altogether.
“When laws like these pass, dentists and patients both benefit because patients receive proper coverage to which they are entitled. Other state dental associations can use this legislation as models for their own proposals to protect the public,” ADA President Chad Gehani, DDS, said in a June 24 statement.
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