Case Studies

Keystone First was denying claims for Application of Hydroxyapatite (D2991) when there was a history of Sealants (D1351), despite no such restriction in Pennsylvania Medicaid guidelines. PA Dental Revenue Partners notified Keystone First about the incorrect bundling being applied. Keystone First identified that claim denials were caused by a benefit administrator (DentaQuest) processing issue, rather than a Keystone First Medicaid coverage policy. Following our escalation, the payer confirmed the issue and coordinated with its benefit administrator, DentaQuest, to correct the claim processing logic.

UHC Community Plan incorrectly denied D1310 and D1330 for adult Medicaid patients (21+). PA Dental Revenue Partners identified the policy mismatch, engaged the payer in February 2026, and presented supporting evidence-leading to statewide reprocessing of denied claims across Pennsylvania in March 2026.