Oklahoma Limits Dental Coverage Denials

The Oklahoma State Legislature recently approved a bill limiting the circumstances under which a dental coverage claim can be denied. The bill, Senate Bill 948, also adds a category of service provider for the treatment of children with autism.

(Related: New Jersey Creates Auto-IRA Program)

The bill is set to take effect on Nov. 1.

Dental Claims

The dental claim section prohibits a dental service contractor from denying a claim, in most cases, if the claim had received prior authorization.

The bill does carve out some exceptions:

• Documents in the authorization request fail to support the claim.
• The patient requires a different therapy than the one specified in the original authorization.
• The patient was ineligible to receive the services on the date of service.
• The claim was fraudulent or contained incorrect information.
• The dentist has already been paid for the claim.

A dental service contractor must issue a prior authorization within 30 days of receipt of the request by a dentist. A dental service contractor needs to confirm coverage and eligibility before providing the authorization for the service date. If it doesn’t, it cannot recoup payment.

New Autism Service Provider

SB 948 also creates a new type of service provider for the treatment of children on the autism spectrum: a board-certified assistant behavioral analyst.

A board-certified assistant behavioral analyst can participate in “applied behavior analysis,” or a form of therapy that seeks to improve social behavior in children with autism.