Thanks to efforts by the American Dental Association, Aetna has resolved a processing issue that affected reimbursements for out-of-network Medicare Advantage dental claims.
A system configuration error had resulted in some dental claims being adjudicated based on Medicare medical rules rather than the rules typically applied to dental benefits, according to information provided by Aetna to the ADA.
Aetna has since reported it is implementing system changes to address the issue and its claims team will adjudicate affected claims correctly while the updates are completed. The team will also review previously impacted claims to determine whether reprocessing and correction are needed.
Source: Aetna resolves Medicare claims-processing error after ADA push / ADA News