Dental Benefit Plans

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This sample letter is for use to respond to a dental plan you are not contracted with claims related to the fee discount of a plan with which you are contracted.

Checklist to help guide a dentist in determining if participation with a new plan fits their model/scope of dentistry, and what to review when evaluating existing plans accepted in the dentist.

This FAQ offers do's and don'ts on how to have patient discussions regarding their dental benefit plans.

Tool to utilize during the patient financial discussion to document financial options presented, patient obligation and financial consent.

Understand the CA law that regulates what dentists can charge patients for procedures that the policy does not cover AB 2275.

This is a handbook contains summary of key information and requirements of the Medi-Cal Dental Program program.

CDA recently became aware of a court ruling in the Moneim, DDS, et al., vs. Delta Dental of California litigation. It is our understanding that the court has ruled on some of the legal issues involved in this case, but this ruling is only part of the case as the court divided the case into 2 phases.

This resource will introduce you to the basics of offering an in-house discount plan. These in-house discount plans offer patients some form of dental coverage or benefit to offset their out-of-pocket cost making it more likely that they will 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.

Format and content, patient access to records and requests to amend, disclosure of information, data breach notification, retention and disposal, transferring records in a sale.

Includes information on this patient right to restrict disclosure of patient health information to a dental benefit or health care plan and a sample form to use for a patient who requests such a restriction.

Dentists can avoid unnecessary stress by seeking guidance from CDA Practice Support before complying with a dental benefit plan’s request to conduct a post-payment chart review of patient records. 

There are two levels for appealing payment disputes: first with the plan itself, then with the appropriate regulatory agency. This resource provides a detailed list of contacts and appropriate processes to follow.

Understand how a dentist's absence in the practice could result in dental claim processing issues and how to develop a plan of action to reduce complications.

Outlines sample policy language and considerations for billing when employees have dental benefit plan coverage. 

This resource provides information on the state law regarding refund demands from a benefit plan when a patient's coverage has been retroactively terminated.  Includes a sample letter to dispute a refund request from a benefit plan after the plan has paid for services rendered.

Use this sample letter and instruction to inform dental plans of a business Tax Identification Number change.

This sample letter should be customized and printed on office letterhead to notify a Third Party Payer when a temporary dentist will be filing in for a dentist on a leave of absence.  Commonly used in Locum Tenens, Disability Leave, Maternity Leave and other situations in which a licensed dentist who is not currently practicing at the office will temporarily be performing treatment on patients on behalf of a licensed dentist that is currently practicing at the office.

Information regarding the requirements to comply with the No Surprises Act which became effective January 1st, 2022.  The No Surprises Act is an effort to protect individuals and provide transparency related to health care costs. Instructions as well as samples of the required notification and the Good Faith Estimate are included.

Q&As, coding information and a sample notice and consent form required by the Dental Board.

This resource lists frequently asked questions around the practice of dental benefit plan network leasing/sharing. The resource will provide you with insight into the practice of PPO network buying and leasing/sharing.

CDA has received an influx of member inquiries regarding the recent wave of Delta Dental of California’s Quality Assessment audits. On-site reviews are part of Delta Dental’s Quality Assessment program for contracted dentists in California, mandated by the California Department of Managed Health Care. These reviews evaluate many components of a practice compared to the expectations of dental professionals, regulatory agencies and Delta Dental.

A guided checklist to assist dentists with things to consider before, during and after withdrawal from a plans network, including sample letters for use in your practice.

Dental plans conduct credentialing, which is the collection and verification of an applicant’s professional qualifications such as relevant training, licensure, certification, and/or registration to practice in a health care field and academic background, as well as an assessment of whether the practitioner meets certain criteria relating to professional competence and conduct.