Dental providers may negotiate some insurer contract terms together

Two or more dental providers may negotiate together with an insurer about specified contract terms. Providers must practice in the insurer’s service area. They may discuss nonpayment contract terms such as coverage rules, care standards, referrals, and ways to settle disputes. The attorney general must authorize the talks, and the insurer and all participating providers must give written consent. Talks may not cover payment amounts, discounts, covered procedure codes, or other matters directly tied to provider payments or revenue. The process does not apply to plans serving only or mainly people eligible for medical assistance. It does not allow providers to coordinate stopping or limiting dental services. Before talks begin, a representative must notify the attorney general. The attorney general generally must decide within 90 days; the parties may approve a 30-day extension.

The attorney general reviews proposed negotiated terms and decides whether they are authorized. If the parties reach agreement on negotiated terms, their representative must submit the proposed contract or agreed terms for review. The attorney general may weigh fairness, bargaining power, possible benefits to patients, risks to competition, and effects on price, quality, choice, or access. The attorney general may request more information and may limit providers’ communications during negotiations. The attorney general must decide within 90 days after receiving the proposed contract or agreed terms.