Revises provisions relating to claims for dental care. (BDR 57-573)
What changed between versions
Dentists are now authorized to submit requests for external reviews of adverse determinations regarding dental care, a right previously reserved for physicians.
Independent review organizations must now notify dentists of a covered person and forward information received from them, just as they do for physicians.
Decisions by independent review organizations must now include any recommendations made by the insured's dentist as part of the documentary evidence.
The definition of 'clinical peer' was revised to include dentists, ensuring they are treated equally to physicians during external review processes.
The requirement for insurers to establish complaint resolution systems and provide external reviews now applies to policies providing only dental coverage, whereas these were previously exempt.