Section 31A-26-301.7 - Dental claim transparency(1) As used in this section: (a) "Bundling" means the practice of combining distinct dental procedures into one procedure for billing purposes.(b) "Dental plan" means the same as that term is defined in Section 31A-22-646.(c) "Downcoding" means the adjustment of a claim submitted to a dental plan to a less complex or lower cost procedure code.(d) "Covered services" means the same as that term is defined in Section 31A-22-646.(e) "Material change" means a change to: (i) a dental plan's rules, guidelines, policies, or procedures concerning payment for dental services;(ii) the general policies of the dental plan that affect a reimbursement paid to providers; or(iii) the manner by which a dental plan adjudicates and pays a claim for services.(2) An insurer that contracts or renews a contract with a dental provider shall: (a) make a copy of the insurer's current dental plan policies available online; and(b) if requested by a provider, send a copy of the policies to the provider through mail or electronic mail.(3) Dental policies described in Subsection (2) shall include: (a) a summary of all material changes made to a dental plan since the policies were last updated;(b) the downcoding and bundling policies that the insurer reasonably expects to be applied to the dental provider or provider's services as a matter of policy; and(c) a description of the dental plan's utilization review procedures, including:(i) a procedure for an enrollee of the dental plan to obtain review of an adverse determination in accordance with Section 31A-22-629; and(ii) a statement of a provider's rights and responsibilities regarding the procedures described in Subsection (3)(c)(i).(4) An insurer may not maintain a dental plan that: (a) based on the provider's contracted fee for covered services, uses downcoding in a manner that prevents a dental provider from collecting the fee for the actual service performed from either the plan or the patient; or(b) uses bundling in a manner where a procedure code is labeled as nonbillable to the patient unless, under generally accepted practice standards, the procedure code is for a procedure that may be provided in conjunction with another procedure.(5) An insurer shall ensure that an explanation of benefits for a dental plan includes the reason for any downcoding or bundling result.Added by Chapter 288, 2021 General Session ,§ 2, eff. 5/5/2021.