Why Your UCRs Matter More Than You Think in PPO Negotiations As the founder of PPO Advisors, I’ve worked with countless dental practices across the country. One of the most common — and costly — mistakes I see is practices setting their Usual, Customary, and Reasonable (UCR) fees too low. What many providers don’t realize ...
If your dental practice treats Medicare Advantage patients, 2026 will bring some of the biggest changes we’ve seen in years—especially with Aetna. While insurers have been quietly tightening networks and trimming benefits, Aetna’s most recent move will directly affect how dental providers can participate in its Medicare Advantage network. Aetna’s Changes in a Nutshell Nearly ...
Q1: At a high level, what does PPO Advisors do, and how did you get started? A: Absolutely. I’m Shelley DeGroff, founder and CEO of PPO Advisors, formerly known as IDS PPO. We’ve been in business since 2013, now operating under the name PPO Advisors (ppoadvisors.com). Our mission is clear: we provide ppo solutions and ...
By Shelley DeGroff, Founder of PPO Advisors Why This Blog Matters There are many credentialing platforms that dental networks utilize—CAQH, DentalXChange, and now most recently, Skygen. The challenge? There’s no unified system, and each network chooses its own path. That leaves practices constantly guessing which portal to use, and when. This blog isn’t about endorsing ...
By Shelley DeGroff, Founder of PPO Advisors If you’ve ever had money pulled from your claim payments because of an overpayment made to a completely unrelated provider—buckle up. You’re going to like this. MetLife just announced they’re changing how they handle overpayment recoupments. Thanks to pressure from the ADA, they’ve agreed to stop taking money ...
By Shelley DeGroff, Founder of PPO Advisors A big change is coming this fall that could impact your PPO reimbursements, and I want to make sure you’re ready. Starting September 1st, 2025, Aetna and MetLife will roll out a two-way share agreement that affects how you’re connected to patients across both networks. As the Founder ...
By Shelley DeGroff, CEO of PPO Advisors As the CEO of PPO Advisors, I’ve witnessed firsthand how outdated PPO contracts can silently erode a practice’s profitability. Many providers are unaware that simply updating their CAQH profile can inadvertently recredential them into old contracts, leading to decreased fee schedules and unintended contractual obligations. The Hidden Dangers ...
By Shelley DeGroff, CEO of PPO Advisors Following the overwhelming response to our recent blog addressing the confusion around Guardian Dental’s lease affiliations with Careington and Connection, we were contacted directly by Guardian for a conversation. We appreciate their willingness to engage with us and begin clarifying the facts of this complex situation. Here are ...
The Guardian Dental Network Shake-Up: What Providers Need to Know By Shelley DeGroff, CEO of PPO Advisors Lately, there’s been a lot of noise surrounding Guardian and its relationships with shared networks and third-party lease arrangements—particularly with Careington and Connection. As a company deeply entrenched in navigating the PPO landscape, we’ve been watching this situation ...
Big News: United Healthcare & United Concordia Elite Plus — What It Means for Your Practice By Shelley, CEO & Founder of PPO Advisors If you’ve been paying attention to the latest insurance developments, you may have heard the announcement about United Healthcare’s new relationship with United Concordia Elite Plus, set to take effect in ...