WHAT'S NEW

What's New

  • Vaccine Update for Oral Health Professionals +

    4-7-21 If you are a dental professional that has not yet received the COVID-19 vaccine, visit the LDH website for vaccine locations and search by parish. There are plenty opportunities Read More
  • ADA's COVID-19 Response: We've got your back. Always. +

    Please watch this three-minute video produced by the ADA outlining how they have supported members throughout the pandemic and will continue to do so. ADA and LDA have your back! Read More
  • LDA Legislative Session 2020 Successes +

    Thanks to the hard work and determination of your LDA leadership, the LDA lobbying team moved forward during the hectic, 28-day legislative session with two of our pieces of insurance Read More
  • DentaQuest and MCNA Both Louisiana Medicaid MCOs +

    Medicaid Provider Trainings LDH in coordination with DXC/Gainwell Technology is planning to host several web trainings for dental providers beginning November 30th regarding the Medicaid Eligibility Verification System. With the Read More
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Thanks to the hard work and determination of your LDA leadership, the LDA lobbying team moved forward during the hectic, 28-day legislative session with two of our pieces of insurance legislation. Members from all over the state called their legislators and responded to our call-to-action alerts. The ADA also supported our efforts as part of the State Public Affairs program. 

Our advocacy efforts worked; this is organized dentistry at its finest - promoting, advocating and protecting the dental profession! 

 The Governor signed both bills, and they are effective on August 1, 2020. Click here to read the ADA News article about Louisiana's success!

HB311 (now Act 256) by Rep. Mike Huval – Prohibits the denial of claims based upon preexisting conditions. Also called the “missing tooth clause” bill, HB311 prevents a dental service contractor from denying a benefit for covered dental services to treat conditions existing prior to the date the coverage begins. A dental service contractor may impose up to a 12-month waiting period for covered services.

NOTE: As our pre-existing conditions law is so new, some of the third party payers have denied claims since Aug. 1. If the procedure was after Aug. 1 (or it is a prior authorization) and the insurance company is denying the claim after you have sent them a copy of the new law during an internal appeal with the insurance company, file a complaint on the LA Department of Insurance website at: http://www.ldi.la.gov/  (Click on File a Complaint, then select Consumer.)

HB353 (now Act 187) by Rep. Chad Brown – Prohibits a dental service contractor (third party payer) from systematically downcoding with the intent to deny reimbursement otherwise due to a dentist or other healthcare provider. It also prohibits downcoding the installation service of a fixed bridge to a removable bridge.

Additionally, if a procedure code change is made, the explanation of benefits (EOB) provided to the patient shall include the reason for the downcoding and citation of the dental service contractor's applicable policy. The EOB shall not state or infer that the code billed by the dentist or other healthcare provider was inappropriate unless there is clear evidence the code listed on the claim by the provider in no way related to the procedure performed. The EOB shall not state or infer that the healthcare provider's charge was excessive unless there is clear evidence the charge was substantially higher than the provider's regular fees. The third party payer shall disclose in its provider contracts, on its website, or both, the specific downcoding policies that the dental service contractor reasonably expects to be applied to the provider or provider's services on a routine basis as a matter of policy.
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5637 Bankers Ave.
Baton Rouge, LA 70808
(225) 926-1986  |  (800) 388-6642
(225) 926-1886  Fax
info@ladental.org

Links with this symbol are password protected for LDA members only.
5637 Bankers Ave.
Baton Rouge, LA 70808
(225) 926-1986  |  (800) 388-6642
 Fax (225) 926-1886
info@ladental.org