How to contract with third-party payers

Contracting with third-party payers can prove complicated but with some diligence and attention, new dentists can feel confident they were thorough in their decision.

Patients are two and a half times more likely to visit the dentist if they have dental benefits. Nearly 187 million Americans were covered by some form of dental benefit in 2012, according to a report from the National Association of Dental Plans and the Delta Dental Plans Association.

In 2013, a typical dental practice had nearly 72 percent of its patients with some form of a dental benefit, making it challenging for dentists to decide whether to participate in a network or not. On average, dentists participate in five and a half managed care plans.

Here are some steps the ADA recommends new dentists take when beginning the process of contracting with a dental benefits company:

• Figure out the volume of patients you expect to see and whether the fees proposed by the third-party payer work for you. The ADA Benefit Plan Analyzer allows dentists to run “what if” scenarios that will illustrate the financial impact to their practice. It’s available on the ADA Center for Professional Success website at Success.ADA.org.

• Carefully review the contract between you and the thirdparty payer. A contract is a legal document and by signing it, you are making promises that you must keep.

• Consult with your personal attorney before signing. The ADA Contract Analysis Service is also an option. Members may submit a contract to their state or local dental societies, who will forward it to the service, which provides a plain language explanation of contract terms of each agreement analyzed. The service does not provide legal advice or recommend whether a contract should or should not be signed.

• Determine whether the contract presented includes terms such as an all affiliated carriers clause, most favored nation clause or hold harmless agreement. Also pay attention to the carrier’s processing policies, which may or may not appear in the contract.

• Review the plan’s website and provider participation manuals carefully. Understand how changes to these will be communicated to you and your rights when changes are made. If you still have questions, talk to a representative from the plan to clarify.

The ADA Center for Professional Success has a series of videos that will help dentists understand how third-party payers interface with dental offices. Click here, to watch the tutorials.

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