The Practicon Viewpoint by Ann Page Griffin

HELP! I CAN'T UNDERSTAND THE PPO CONTRACT I AM BEING OFFERED

Did you know help is available to unscramble the "legalese" of managed care organization provider contracts? As participation in managed care networks has increased, the American Dental Association has created several resources to help dentists get answers to questions about dental benefit plans and provider network contracts. The third-party payer complex can be bewildering, and the ADA strongly recommends that dentists seek complete understanding of all conditions and requirements before signing any contracts.

ADA resources include:

• The ADA Contract Analysis Service—part of the ADA Division of Legal Affairs, provides a plain language explanation of any proposed provider contract and is available free of charge to ADA members who request an analysis through their constituent dental society.
• ADA Guide to Dental Benefits—part of the ADA Center for Professional Services; a landing page for dental benefit resources.
• ADA Dental Plans Overview—provides information on a number of provider contracts.

Further, specific information on problems or questions related to dental benefits, such as coding on claims, is available to ADA members at the ADA Center for Dental Benefits, Coding and Quality by email at dentalbenefits@ada.org or by telephone at 1-800-621-8099.