Breaking News from AAOMS!
Important Change to Guardian’s Clinical Policy on Third Molars
The information below is a direct benefit of member support for the work done at the national office and from membership involvement on AOMS committees. In this case, it is Karin Wittich’s team and the Committee on Health Care Policy, Coding, and Reimbursement (CHPCR) who’ve had this success. The information should be distributed to the WSOMS membership. –Mark Egbert, AAOMS District VI Trustee
Guardian has reversed their clinical review policy requiring each claim for third molars and associated IV sedation and general anesthesia be reviewed for medical necessity:
“While the change was made to align with the industry and clinical recommendations, it caused more disruption than expected. Therefore, effective immediately we will no longer apply medical necessity review criteria to third molars and associated IV sedation or general anesthesia. As a dental market leader, it is important for us to balance new clinical science with current clinical practice. We continue to explore ways to best meet the needs of patients while at the same time listening to provider feedback.”
Guardian will automatically reprocess any denied claims retroactive to April 26, 2018; Claims should all be reprocessed within 45 days. Guardian will also be mailing postcards to the OMS’s in their database relaying this information. The importance of AAOMS being at the American Association of Dental Consultants (AADC) annual meeting cannot be over emphasized, as well as the relationships we have built with the carrier representatives. Thanks go to Guardian on behalf of AAOMS and the OMS community for their willingness to work together and for making this important change.
From Karin K. Wittich, CAE Associate Executive Director, Practice Management & Government Affairs, AAOMS