Unmasking the Repricing: Identifying Your Dental Claims' Umbrella Networks

Decoding the Repricing Mystery: A Focus on CDT D2740

Understanding how your claims are being repriced is crucial for maintaining a healthy revenue cycle. Consider the CDT D2740, Crown – porcelain/ceramic substrate, where rates can vary significantly. For instance, Aetna's average negotiated rate is $254.53, while Delta Dental of Michigan offers a much higher average of $727.21. This disparity highlights the need to identify which umbrella networks are repricing your claims and affecting your bottom line.

Carrier Comparisons: Aetna vs. Delta Dental of Michigan

Let's delve deeper into the numbers. Aetna's average rate of $254.53 is significantly lower than Delta Dental of Michigan's $727.21. This $472.68 difference per claim can add up quickly. If your practice processes just 100 claims annually at these rates, the difference in revenue could be as much as $47,268. This stark contrast underscores the importance of knowing which network is influencing your payment rates.

State-by-State Disparities

Location is another factor that can dramatically affect your negotiated rates. For CDT D2740, the average rate in California is $833.75, while Wyoming's average is a mere $89.77. That's a staggering $743.98 difference. Practices in New York enjoy an average of $981.6, while those in Washington receive $957.25. These state-by-state variations can dramatically impact your practice's revenue, depending on where your claims are processed.

How to Identify Your Repricing Network

Identifying which umbrella network is repricing your claims involves a systematic approach:

• Gather Your Data: Start by collecting all your EOBs and remittance advices. Look for patterns in the rates and any mentions of third-party administrators or network names.
• Use PayorMap: Leverage tools like PayorMap to access real negotiated rate benchmarks and identify leasing relationships. PayorMap can show you which networks are linked to your carriers and how they might be affecting your rates.
• Analyze Rate Discrepancies: Compare your practice's rates against PayorMap's benchmarks. Look for significant discrepancies that might indicate repricing by an umbrella network.