PPO Negotiations hope this finds you well. 2020 will definitely be ONE for the record books! First there was Covid-19 and now a change of the Network Administrator for BCBSM that struck the dental industry as of October 1, 2020
Our goal is to make sure you and your practice(s) are aware of the BCBSM changes. There was no formal public announcement to allow practices the opportunity to make necessary changes in their participation level. I can honestly say, based on our investigative calls, everyone has been blindsided. Representatives at BCBS, Dentaquest, and UCCI were not prepared for this major change. It has taken us at least 4 days to figure out what has been going on and the impact it will have on dental practices. I have shared what we have learnt thus far:
As of October 1st, United Concordia ( UCCI) became the primary network partner for the BCBS of Michigan [ BCBSM] Commercial Plans. This means, UCCI will manage all IN-NETWORK provider contracts and are now responsible for maintaining provider records. As you and your offices may remember, it was a nightmare when BCBSM changed their claim administrator from DNOA to Dentquest back in November 2019. At that time, offices were being seen in networks with Dentamax that either never credentialed with Dentemax or termed with Dentemax.
We are noticing BCBS providers in the state of Michigan are experiencing one or more of the following…..
◾Providers “OON” with BCBSM are now being seen in-network with Dentemax under UCCI system which means their BCBSM claims will be paid on the Dentemax fees
◾Providers ” UNDER ASSIGNMENT” with BCBSM are now being seen ” IN NETWORK” with a UCCI network group, which means their BCBSM claims will be paid on the fees associated with that network.
◾Providers who had BCBSM claims paid under one of the listed groups may notice their claims are being paid under one of the other groups listed – depending on the process UCCI determines to pay the claims under. ..
Careington Care Connection Principle
Maverest DNOA UCCI
Dentemax
We advise your admin team to keep a watchful eye on the BCBSM EOB’s for services rendered post 10-01-2020 to ensure they are being paid properly. In the event they are not, Dentaquest is suggesting all providers reach out to UCCI at 800-307-8514 to begin the troubleshooting process.
We at PPO Negotiations are working on how to strategically help our clients achieve the highest level of reimbursement from this Network change that stormed the dental field. Please contact us if you are having difficulty in correcting your provider status with UCCI.
Local: 586.803.7501
Toll Free: 888.421.1808