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Publication: Becker's Dental Review

Publish Date: March 21, 2017
By Marcel Tetzlaff


Building a network of high-quality dentists is critical to the success of Medicaid dental programs. Yet as many Managed Care Organizations have discovered, getting those dentists into the network, and keeping them there, can be challenging. Particularly in these uncertain times.

The main barrier is usually that Medicaid programs pay only a fraction of what commercial plans offer. As a result, dentists may feel a compelling reason to join, which usually comes from a moral, altruistic calling to serve the most vulnerable population coupled with a desire to expand their patient rosters.

While those are good reasons, they may only appeal to a certain percentage of dentists. In many cases, this number is not enough to deliver full, quality coverage to those in need. What MCOs really need to expand their networks are new strategies that deliver value to dentists as well as their own organizations while building a stronger relationship.

Following are three ways MCOs are pumping new life into Medicaid dental programs through innovative approaches such as daily payments, creating a systematic approach to recognize dentists who provide appropriate and efficient care while acting as good stewards of taxpayer money, and delivering more flexible authorization and reimbursement schedules.

Daily payments

The only thing worse for a dentist than being reimbursed at a discounted rate is having to wait days or weeks to receive that money. This is the scenario a daily payments plan can help dentists avoid. With daily payments, dentists can see money from services rendered to their Medicaid patients come in every business day, giving them an attractive cash flow that offsets some of the low reimbursement rates. Making such a program work, however, requires a commitment on the part of dentists and MCOs.

Dentists must submit clean electronic claims rather than using paper claims, and they must agree to be paid electronically. Moving to submitting claims electronically through a portal rather than via paper and mail should be an easy decision for dentists. Not only does it help dentists get paid faster in general. It also eliminates problems from claims getting lost in the mail or data entry errors on the MCO’s side.

Submitting claims electronically requires significantly less time and money than using paper and snail mail. Because information can be stored and pre-populated, it also reduces the instances of human error that can cause a claim to be held up or denied. In fact, many inadvertent submission errors, such as forgetting to include an attachment, can proactively be detected, offering dentists a chance to make a correction before the claim is submitted.

On the other side, MCOs must implement technology-driven continuous claims processing that instantly processes all clean electronic claims. This system would take the place of the industry standard of following a batch cycle that can take up to two weeks or more.

MCOs must also be willing to fund the program with their dental benefit administration partner on a daily basis. Although MCOs may lose the benefit of not leaving the money in the bank for a few more days, the greater benefit is the long term investment of attracting more high-quality dentists to the dental provider network and building the organization’s reputation as a good partner to the states it serves.

Dentist recognition program

A good way to attract and keep more high-quality dentists in a Medicaid network is to recognize them for doing a great job. By taking advantage of specialized big data analytics, MCOs can measure the performance of dental providers against their peers in a particular market. They can then use that information to identify the top performers – the ones who are delivering the most appropriate and efficient care, and are focused on the best interests of the program.

Armed with that information, MCOs can offer various types of recognition to drive more patients to dentists who are top performers. For example, rather than basing “find a dentist” listings only on location, MCOs can return results that show the highest-performing dentists within the distance requirements at the top of the list, even if they are not the closest. They can offer recognition on their websites and through plaques or certificates that can be placed in the waiting area to show that dentist has met the highest quality standards, giving patients more confidence in them.

Offering these advantages doesn’t just recognize the dentists who are meeting the standards. It also encourages the same positive behaviors throughout the market, making it a win for dentists, MCOs and Medicaid patients.

Faster claims processing and authorization schedules

Big data analytics can also be used to improve the relationship between dentists and MCOs by making operational changes that recognize excellence. One simple example is eliminating the administrative burden of prior e-authorizations on a case-by-case basis.

Dentists who have demonstrated they are delivering a high level of appropriate and efficient care can be pre-approved for certain procedures, removing the need to request authorization first. Offering this benefit saves time and money, enables greater efficiency, and establishes a higher level of trust between dentists and MCOs.

Additionally, high-performing dentists who are known to submit clean electronic claims on a regular basis can have their claims automatically fast-tracked to ensure they receive reimbursement with the quickest possible turnaround time.

Bringing out the best

Building a Medicaid dental network can be challenging in the best of times. In today’s healthcare climate it can be even more difficult.

By working together to build programs that benefit both sides, and using technology to increase speed and reduce costs, MCOs and dentists can improve the quality, efficiency, and availability of dental care while reducing the cost. All of which fulfill the goal of making more and better care available to more Medicaid members.

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