![]() While such closed panel plans have typically been used by DHMOs they are now starting to gain popularity with PPOs as a mechanism to control costs.ĭentists should be prepared to talk to patients about the repercussions of these types of closed panel plans. There is no benefit payable to an out-of-network dentist under an EPO plan. In EPO plans the patient will need to bear all costs of care if they choose to go to an out-of-network dentist, whereas in a PPO the patient may incur greater out of pocket costs but would still receive a benefit. EPO plans are very similar to PPOs but require that patients use only participating dentists for services covered by the plan (these are also referred to as “closed panel plans”). Traditional PPOs pay a percentage of the maximum allowable fee to the contracted dentist. Your patient may be covered under an emerging model of benefit plan, called an exclusive provider organization (EPO).Ī preferred provider organization (PPO) is a managed care plan combined with a network of dentists under contract to the third party carrier to deliver specified services for set fees according to the provisions of the contract. These documents have useful information to help dentists better understand what an SRP entails, including an overview of common concerns, information on recording attachment loss, periodontal charting, examples of SRP processing policies and examples of good and poor radiograph submissions for SRP Claims.Ĭlaims Submission: Scaling and Root Planing - Long Version įor your convenience, there is also a summary version of the above document.Ĭlaims Submission: Scaling and Root Planing - Short Version Periodontal scaling and root planing (SRP) procedures (D4341 and D4342) tend to have a higher frequency for denial and/or requests for additional information from dental plans in comparison to many other procedures – and this can be for a variety of reasons. In addition to other procedures that are frequently denied reimbursement by payers, dentists report concerns with the large number of denials, alternate benefits and requests for additional information from dental insurers as it relates to scaling and root planing claim submissions.
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