Tricare Changes
Instead of the military contracting its own providers, they lease providers through existing PPOs. United Concordia has been awarded the TRICARE Dental Plan (TDP) five year contract which will take effect May 1, 2017. MetLife had the contract until April 30, 2017. TDP offers comprehensive dental coverage to Uniformed Service active duty family members, National Guard, and Reserve members and their families.
United Concordia will continue to administer Active Duty Dental (ADDP), and Delta Dental will continue to administer the TRICARE Retiree Dental Program (TDRP).
Under the new TDP contract, some dental benefits will expand, including the annual maximum benefit for users which will go from $1300 to $1500. Sealants will be completely covered at zero out of pocket cost and were previously only covered at 20%. Other services will remain the same.
As a dental provider, if you were previously seeing TDP members through your Metlife contract on your Metlife fee schedule, you will need to enroll with United Concordia’s Tricare Dental contract. This is separate from the United Concordia PPO contract and reimburses on a different fee schedule. The TRICARE/ADDP fee schedules have “DoD [Department of Defense] Programs” printed at the top.
You can contract with just TRICARE and/or ADDP without enrolling with United Concordia, and vice versa.
TRICARE: https://www.uccitdp.com/dtwdws/member/landing.xhtml
ADDP: https://secure.addp-ucci.com/dwaddw/home.xhtml
Download Metlife TriCare Tranisition PDF
How can you stay on top of constant PPO changes?
As a dental provider, or dental staff member, your job is busy enough with treating, scheduling, and taking care of your patients. Who has time to manage, negotiate, and stay on top of all these PPO Insurance companies? We at Unitas specialize in PPO negotiations, management and participation optimization. We’ve helped thousands of dentists increase their PPO revenue, and untangle themselves from the frustrating PPO insurance web. To learn more about how we can help your practice, take our free PPO Revenue Assessment, which will help determine your PPO negotiation eligibility. Or feel free to Click here to schedule a free consultation with us today.
2017 ADA CODE CHANGES
New ADA Codes:
D0414 Laboratory processing of microbial specimen to include culture and sensitivity studies,
preparation and transmission of written report.
D0600 Non-ionizing diagnostic procedure capable of quantifying, monitoring, and recording
changes in structure of enamel, dentin, and cementum.
D1575 Distal shoe space maintainer — fixed — unilateral.
D4346 Scaling in presence of generalized moderate or severe gingival inflammation — full
mouth, after oral evaluation. The removal of plaque, calculus and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. Should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.*
D6081 Scaling and debridement in the presence of inflammation or mucositis of a single
implant, including cleaning of the implant surfaces, without flap entry and closure.
D6085 Provisional implant crown.
D9311 Consultation with a medical health care professional.
D9991 Dental case management — addressing appointment compliance barriers.
D9992 Dental case management — care coordination.
D9993 Dental case management — motivational interviewing.
D9994 Dental case management — patient education to improve oral health literacy.
*There code is for patients in-between those who only need a regular prophylaxis and those who are not quite to the scaling and root planing stage of treatment yet.
Deleted ADA code:
D0290 Posterior-anterior or lateral skull and facial bone survey radiographic image.
See also Pediatric Dentistry Today which provides additional insight on the new codes and Cigna’s publication regarding coverage for new codes. (attached)
Download PDF of 2017 Code Changes Dowload PDF Code Explanation sheet
PPOs change regularly, how are you keeping up?
As a dental provider, or dental staff member, your job is busy enough with treating, scheduling, and taking care of your patients. Who has time to manage, negotiate, and stay on top of all these PPO Insurance companies? We at Unitas specialize in PPO negotiations, management and participation optimization. We’ve helped thousands of dentists increase their PPO revenue, and untangle themselves from the frustrating PPO insurance web. To learn more about how we can help your practice, take our free PPO Revenue Assessment Quiz, which will help determine your PPO negotiation eligibility. Or feel free to Click here to schedule a free consultation with us today.