Page 5 - GDP - Provider Reimbursement Guide 2022

General Provider Performing Specialty Treatment
All general providers have the option to contract with GDP as a General Dentist Providing Specialty Treatment. By signing up as general dentist providing specialty care the provider shall be reimbursed on a fee for service basis at 70% of UCR. By contracting with GDP as a general dentist providing specialty treatment your facility will be added to GDP’s specialty provider directory.
• GDP in-network general providers may refer a member to your facility for a specialty procedure, referrals do not need to be assigned to your facility for specialty care.
• If the member is a current patient of record (assigned to your facility) and you submit a claim
for specialty payment, only the specialty treatment lines would be paid as fee for service at
70% of UCR, all other non-specialty treatment lines such as exams or x-rays would be processed under CAP.
• For patients that are referred to your office as opposed to being assigned to your office, provider will receive 70% of UCR for all treatment including x-rays and exams.
• All patients referred to your facility will need a GDP referral form from the referring general provider. This form must be attached to all specialty claims for payment. If the provider intends to submit a claim as specialty, the member will be required to sign the specialty authorization form and this form must be attached to the claim to receive specialty payment. If the specialty authorization is not attached specialty payment will not be processed until authorization form is received. Please see copy of specialty authorization form on page 16 of this document.
• If a case is referred to the doctor for specialty treatment and the doctor is not comfortable doing the procedure for any reason the doctor may deny the case and refer the patient back to referring dentist or contact GDP for further referral assistance.
Orthodontics
If your practice provides orthodontic treatment and you are interested in becoming an in-network orthodontist, please contact GDP for contract details.
Mission Statement
Building mutually beneficial long-standing relationships with local dentists has been vital to our success. Our promise is to work in unison with the practice to promote oral health, enhance patient base, increase revenue, and reduce empty chair time. These goals shall be identified early and reviewed on an annual basis to ensure a harmonious business relationship.
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