MDA Confirms, Clarifies Credentialing Request T

his notice is to update our members about recent calls we have received related to cre- dentialing/re-credentialing with United Concordia.

Many providers received letters in March that included logos of VerifPoint, United Concordia and the Council for Affordable Quality Healthcare (CAQH). The letter indicated that the State adopted the CAQH credential- ing application and “accordingly, your state is requiring that all providers complete the CAQH application for credentialing/ re-credentialing purposes”. This created confusion because many providers were unaware of Ver- ifPoint’s involvement with the United Concordia credentialing process. Providers also ques- tioned if the State was actually

requiring re-credentialing of all providers at this time through the use of the CAQH form.

We agreed that the letter was misleading and evaluated its veracity. Based on research performed by the ADA and the MDA, it was determined that the letter was, in fact, legitimate. As dentists are aware, most insurance companies require re- credentialing of their providers every 3 to 5 years.

In response to our request for clarification, United Concor- dia explained that it is using a credentialing vendor, VerifPoint for purposes of credentialing its providers. This explains the use of the VerifPoint and United Concordia logos in the letter. United Concordia indicated

that it communicated the use of VerifPoint for the credentialing process to providers in its 2013 newsletters. Nonetheless, United Concordia understands the confusion caused by the verbiage in its provider letter, and will be making some changes to the letter for future communica- tions. United Concordia also will continue to communicate to providers regarding credential- ing/re-credentialing requests through its newsletter and other methods.

With respect to the use of the CAQH form, the State of Mis-

souri has adopted the UCDS form published by CAQH. The state may adopt other forms upon approval of the Director of the Department of Insurance (DOI), however, according to the DOI’s website, the only approved form for HMOs/PPOs is the UCDS form published by CAQH. Accordingly, the credentialing form utilized by United Concor- dia is appropriate and explains the inclusion of the CAQH logo on the provider letter.

Please contact MDA if you have further questions regarding this matter.

Claims Submission for Medical Plans with Embedded Dental Coverage

The following update has been provided by the ADA. Of interest is that this issue was brought to the attention of the ADA by MDA member, Dr. Darren Mahaffey, Springfield. Dr. Mahaffey contacted Dr. Mark Zust (ADA Sixth District Trustee) who connected him with the appropriate ADA staff member. Dr. Mahaffey spoke on the phone with that staff member to let him know what he was seeing happen and to ask if he had heard of this from any other doctors, which he had not. This is one example of the Power of Three—membership in your local, state and national dental organizations. You may always contact Dr. Mark Zust, your Sixth District Trustee, for questions you may have. Email zustm@ada.org.

S

ince the Affordable Care Act passed, the number of medical plans offering embedded dental coverage has increased significantly. Even though these are medical plans, the plans will still accept dental claim forms and CDT procedure codes; however, there may be confusion as to where to send the dental claim. Do you send the claims to the medical plan or is there a separate ad- dress for the dental benefits coverage? This is a relatively new concern that dentists have with these types of embedded plans.

Recently, a member dentist received a claim denial for a patient who had dental cover- age through the patient’s medical plan. The dental office submitted the claim to the address for the medical plan which was printed on the patient’s ID card. The doc- tor was surprised when the explanation of benefits (EOB) statement arrived at his office indicating that the claim was denied because “dental was not covered.” Upon investiga- tion, it became apparent that the dental benefit coverage was provided by a different company (a company that was not providing

the medical coverage). Unfortunately, the address for dental claim submission was not on the patient’s ID card. The dentist had to call a phone number provided on the ID card to obtain the information for the dental plan. Given that more medical plans are offering embedded dental coverage, when a patient presents with a benefit plan that you may not be familiar with, we recommend that dental offices call the toll free dental plan number to get information on the dental claim submission.

NEW HPI WEBINAR RECORDING AVAILABLE // Want to hear the latest on dental benefits options in the health insurance marketplace? Be sure to watch the ADA Health Policy Institute (HPI) webinar summarizing the latest research and discussing key policy issues on the topic. Watch the webinar here: www.ada.org/en/science-research/health-policy-institute/publications/webinars.

ISSUE 3 | MAY/JUN 2015 | focus 17