Don’t Hold Medicaid Claims, suggests ASDA

by Billy Tarpley on October 12, 2018

Dental offices that have been withholding claims awaiting a resolution to the Diamond Plan deferred compensation program should go ahead and file, suggests ASDA.

According to recommendations from both managed care organizations (MCO), Delta Smiles and MCNA Smiles, dentists may be hurting themselves by withholding claims. Until such time as the Diamond Plan is activated for claims through the managed care program, ASDA concurs that dentists should go ahead and file all claims, then set aside the income from the claims. Additionally, in the event that the Diamond Plan is activated as expected, dental offices should continue to schedule Medicaid patients through the end of the current fiscal year so that claims are adequate to fully fund the doctor’s Diamond Plan account. The current annual maximum for 457(b) plans is $18,500.

All claims must be filed within 12 months, and, according to one group, dental offices that withhold claims may adversely affect the amount they are paid. For example, if DHS adjusts a claim after the MCO has processed it, the adjusted amount will reflect the fee-for-service fees rather than the MCO fees. The amount could be lower.

Separately, the state will use the claims experience and utilization rates to determine funding for future years. Withholding claims could skew the overall numbers, which could lead to underfunding of the program.

In trusting DHS to finalize approval and activation of the Diamond Plan, ASDA suggests the following:

  • File all the claims you currently have, and set aside the income.
  • Continue to schedule Medicaid patients through the end of the year to ensure adequate income to fully fund the account.
  • Continue to watch your e-mail. ASDA will notify you as soon as possible when an update becomes available about the Diamond Plan.

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