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Dental Benefit Plan Handbook
Dental Benefit Plan Handbook – Chapter 01: Understanding Dental Benefit Plan Coverage
Overview of the types of dental coverage and the differences between dental and medical coverage, in order to aid dentists in explaining dental coverage to patients.
Dental Benefit Plan Handbook – Chapter 02: Understanding Dental Benefit Plan Contracts & Fees
Defines the types of plans to consider for your practice, contracting & contract analysis, billing & how to establish fees and more.
Dental Benefit Plan Handbook – Chapter 03: Verification and Explanation of Dental Benefit Coverage
Tips for verifying coverage with a patient's plan and providing explanation to help patients interpret benefits, limitations, exclusions, financial responsibility and how to maximize coverage.
Dental Benefit Plan Handbook – Chapter 04: Understanding Coordination of Benefits
Understanding plan policies for coordinating payment of benefits when enrollees or policyholders have more than one dental benefit policy. Explanation of CA law pertaining to coordination of benefits.
Dental Benefit Plan Handbook – Chapter 05: Working with Patients and Their Plans
Help patients understand the relationship the practice holds with plans; overview of: in network, out of network, pre-authorization, predetermination, discounts, dual coverage and claims.
Dental Benefit Plan Handbook – Chapter 06: Completing and Filing the Claim Form
Common reasons for claim delays and denials; correct use of procedure codes, Tax Identification (TIN) and National Provider Identification (NPI); practice’s fee schedule and radiographic image attachments; electronic claim (E-Claim) filing.
Dental Benefit Plan Handbook – Chapter 07: Billing Medical Plans
Learn cross-coding: billing medical insurance in a dental office; how to select the correct CPT code and ICD-10 codes when billing medical plans.
Dental Benefit Plan Handbook – Chapter 08: Explanation of Benefits
Understand the elements of the Explanation of Benefits and what to look for.
Dental Benefit Plan Handbook – Chapter 09: Managing Payment Problems
Learn about your rights and actions you must take when dealing with refund demands made by dental benefit plans.
Dental Benefit Plan Handbook – Chapter 10: Understanding the Claim Appeal Process
California law requires every dental plan to have a formal procedure that providers can use to dispute/challenge actions/decisions made by the plan. Overview of plan legal requirements, steps to appealing claims, filing a payment disputes.
Dental Benefit Plan Handbook – Chapter 11: Understanding Dental Benefit Plan Audits
Understanding dental plan authority in quality assurance assessment audits, requirements for the dental practice and best practices for patient records.