Every July, CDA Practice Support starts hearing from members who have received notice from a dental benefit plan about a forthcoming audit. CDA's dental benefits analyst explains the post-pay audit, when dentists must participate in the audit and dentists' right to appeal the findings.
CDA Practice Support continues to hear from member dentists impacted by Delta Dental of California’s contractual change under Participating Dentist Rule 2, Basis of Fees that took effect September 15, 2018. Dental practices can take action annually to avoid negative impacts.
Cindy Hartwell, dental benefits analyst at CDA Practice Support, reviews how a dental practice can bill properly by registering all treating dentists in the practice with the dental plan or plans.
Delta Dental of California’s proposed reductions to the “maximum allowable fees” for approximately 2,200 endodontists, periodontists and oral surgeons in California will not take effect July 1, as previously scheduled. Instead, Delta Dental has decided to indefinitely postpone the previously announced fee reductions.
CDA has heard from many specialist members — endodontists, periodontists and oral surgeons — who are facing reimbursement reductions under their Premier provider contracts with Delta Dental of California
CDA Practice Support answers a member's question about whether a noncontracted dental benefits plan has a legal right to the contracted fee discount of another plan that the dentist does have a contract with.
California Insurance Commissioner Ricardo Lara last Wednesday issued a notice to California health insurance and specialized health insurance companies, including 55 dental benefits companies, requesting that they “provide their policyholders with a partial premium refund no later than December 31, 2020.
CDA Practice Support is receiving calls from dentists and their staff concerning claim denials for scaling and root planing services by dental benefit plans. In this article, I review the criteria utilized by dental plans when reviewing claims for scaling and root planing and why some of the plan denials are correct based on the American Dental Association’s definition of scaling and root planing.
Patients with some form of dental coverage or benefit to offset their out-of-pocket cost are more likely to accept a treatment plan. Offering an in-house discount plan can assist with attracting new patients and help retain existing patients, particularly those patients without any form of dental coverage.
CDA-sponsored legislation that further increases dental plan transparency became law on Jan. 1. AB 954 requires dental plans to be more transparent about the leasing of dental networks. The new law will reduce patient and dentist confusion caused by the increasing number of plans leasing their networks to other payers, many times unbeknownst to the enrollee or contracted dentist(s). The law took effect for contracts entered into on or after Jan. 1, 2020.
CDA Practice Support receives hundreds of calls each year concerning the coordination of benefits when a patient has more than one dental plan for coverage. Standard COB allows secondary dental plans to pay up to 100% of the covered service, i.e., the primary plan pays the service at 80%, and the secondary could pick up the remaining 20%. Here, CDA’s dental benefits analyst covers the COB basics and answers common questions members have about COB.
Today, many dental benefit plans use auto-adjudication to process a high number of their claims. While auto-adjudication can speed up claim processing, if an office is not aware that this type of technology is being used, the office can be confused and frustrated by processing errors as the result of manual claims submission. The following three examples illustrate how a plan might use auto-adjudication and how that process might affect dental reimbursement.
