Keystone First - D2991 Denials

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.
In Progress - Payer Acknowledged Issue, System Correction Underway

The Problem
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A dental practice experienced repeated denials from Keystone First (Medicaid MCO) for D2991 – Application of Hydroxyapatite Regeneration Medicament when patients had a prior history of D1351 (Sealant) on the same tooth.

These denials do not align with Pennsylvania Medicaid dental coverage guidelines, which do not restrict D2991 based on prior sealant history.

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Our Investigation

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Our team reviewed:

  • Pennsylvania Medicaid dental coverage policy
  • Claim history and denial trends
  • Treatment history and payer adjudication behavior

The pattern indicated that denials were being triggered by benefit administration edits, rather than actual Medicaid coverage limitations.

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Payer Engagement

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We escalated the issue and are working closely with Keystone First.

The payer has acknowledged that the denials are likely due to system-level edits managed by DentaQuest (their benefit administrator) and not reflective of Medicaid policy.

Keystone is currently coordinating with DentaQuest to update their systems and correct the claim processing logic.

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Current Status

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The issue remains in progress, with ongoing communication between our team and the payer.

We continue to monitor developments and advocate for correction to ensure claims are reprocessed in accordance with Pennsylvania Medicaid guidelines and practices are appropriately reimbursed.

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Stay tuned for updates.

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Keystone First - D2991 Denials
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