Case Studies

These real cases show how deep Medicaid policy knowledge can overturn incorrect denials and recover lost revenue.

United Healthcare - D1310, D1330 Denials

Resolved - Statewide Claim Reprocessing Completed

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.

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Keystone First - D2991 Denials

In Progress - Payer Acknowledged Issue, System Correction Underway

Keystone First is denying claims for Application of Hydroxyapatite (D2991) when there is a history of Sealants (D1351), despite no such restriction in Pennsylvania Medicaid guidelines. The issue has been acknowledged by the payer and is being addressed with their benefit administrator, DentaQuest.

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