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Member Support on Third Party Issues

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The ADA strongly opposes interference by third-party payers in the dentist-patient relationship.

Comprehensive ADA Policy on Inappropriate or Intrusive Provisions and Practices by Third Party Payers (PDF, September 2017)

Recent Advocacy to Payers

Ethical Considerations in Dental Claims Adjudication (JADA, June 2017)

Tricare-UCCI Dental Contract Concerns from AAP/ADA/AOMS (PDF, June 2017)

Letter to Empire BCBS Dental HMO Referral Process (PDF, April 2017)

Letter to Delta Dental on Disallow Policy (PDF, June 2016)

Statement Sent to Delta Dental Regarding Scaling and Root Planing (PDF, April 2016)

Top Claim Submission and Processing Concerns

The ADA Council on Dental Benefit Programs continually receives and addresses a variety of dental claim submission and adjudication questions from member dentists and practice staff. Here are the top concerns about dental claims as published in the ADA News. The articles included perspectives from ADA members, National Association of Dental Plan members and the Council on Dental Benefit Programs:

  1. D4341, D4342 coding for periodontal scaling and root planing (SRP) per quadrant for partial quadrant (PDF, November 2006)
  2. D4910 coding for periodontal maintenance (PDF, November 2006)
  3. D2950 core buildup, including any pins (PDF, January 2007)
  4. Pre-authorizations (PDF, January 2007)
  5. Claims processing delays (PDF, May 2007)
  6. Claims payment concerns (PDF, May 2007)
  7. Bundling and downcoding (PDF, June 2007)
  8. Least expensive alternative treatment clause (PDF, September 2007)
  9. Overpayment/refund requests (PDF, February 2008)
  10. Coordination of benefits (PDF, May 2008)
  11. Provider contract issues (PDF, July 2008)
  12. Assignment of benefits to participating dentists only (PDF, September 2008)
  13. Post-utilization review (PDF, October 2008)

Member Support

To receive support and report to the ADA what you believe are abusive practices by third-party payers, please contact:
ADA Member Service Center

Third Party Complaint Form