A dental practice noticed repeated denials from UnitedHealthcare Community Plan (Medicaid) for the preventive CDT codes D1310 (Nutritional Counseling) and D1330 (Oral Hygiene Instructions) when billed for patients 21 years and older.
The payer was denying these services citing age limitations, even though Pennsylvania Medicaid guidelines allow coverage for these preventive services regardless of age.
As a result, the practice had begun writing off these claims.
Our team reviewed:
We identified that the denials were not aligned with Pennsylvania Medicaid coverage rules, which do not impose an adult age restriction for these preventive services.
We escalated the issue to the payer and initiated discussions in February 2026, requesting claim reprocessing in accordance with state Medicaid policy.
By presenting supporting documentation and clearly outlining the inconsistency between adjudication and Medicaid guidelines, we worked collaboratively with UnitedHealthcare to have the claims reviewed.
This marks a significant payer-level policy alignment initiated through the efforts of our team at PA Dental Revenue Partners, resulting in statewide claim reprocessing and a strong revenue recovery outcome for dental practices.
UnitedHealthcare acknowledged the issue and proceeded with statewide reprocessing of previously denied claims, resulting in payment for affected services across Pennsylvania.
We appreciate UnitedHealthcare’s responsiveness in reviewing the findings and aligning claim processing with Medicaid guidelines.
As a result, the practice was able to recover revenue and gained clarity on handling similar claims moving forward, reducing unnecessary write-offs.
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