Dental Benefit Plans

Streamline the claims and appeals process; improve billing procedures; understand contracts; coordinate benefits; and establish fees, discounts and refunds.

Victory for direct-to-consumer orthodontic patient protection bill
10/14/2019
Direct-to-consumer orthodontic patients will gain new protections when CDA-supported Assembly Bill 1519 becomes the law in January 2020. The first of its kind in the nation, the new law will protect patients from DTC orthodontic companies that are putting profits before patients by taking potentially unsafe shortcuts to the accepted standards of care.
Prepare for CDT 2020 dental code changes
09/25/2019
CDA encourages dentists to prepare for CDT 2020 dental code additions, revisions and deletions that go into effect Jan. 1, 2020. The new year will bring 37 new and five revised codes, plus six deleted codes. While dental plans are required to recognize current CDT codes, it is important to keep in mind that they are not required to pay for or provide benefits for the new or revised codes. Dentists should review each dental plan’s payment and processing guidelines to determine whether benefits will be payable.
No 'one size fits all' when it comes to dental benefit contracting
09/11/2019
Adding or dropping a contract with a dental benefit plan is a personal business decision. There is no “one size fits all” in these types of business decisions, as what might work for one dentist might not work for another. You may be asking yourself how a dentist can make a good decision about adding or dropping a dental plan/network participation, but there is one key element in each success story.
What’s covered and who pays what: It’s all in the EOB
08/22/2019
Congratulations — the dental plan paid the claim! Or did they? Confirmation that your claim has been processed comes in two forms: payment and/or an explanation of benefits. An EOB is sent to the patient and/or dental office as a receipt of services provided. Unfortunately, dental plans do not have standardized formats for these documents, which is why it’s necessary for an office to read the EOB completely.
Pause before you comply with a plan's request for post-payment chart review
07/30/2019
Post-payment chart reviews are required by state regulators, such as the department of managed health care and the department of insurance. It is important to understand that the dentist has agreed to these types of reviews by signing their participating provider agreement with the dental plan. But, what happens when a dental plan requests a chart review or audit, but you are not a contracted, participating provider?
Dentists say new process for reporting dental benefits issues is easy, convenient, fast
07/11/2019
If you haven’t heard, CDA recently launched a new process for members to report issues and questions related to dental benefits. Although CDA members have had access to a dedicated dental benefits analyst and Practice Support resources since 2009, the online submission form makes it easier for dentists to quickly reach out for assistance and submit their issues 24/7.
When it comes to dental benefits, ask CDA Practice Support before you act
06/13/2019
The following are the top 10 “post-op” calls related to dental benefits that CDA Practice Support has received from dentists who made a decision, whether through action or inaction, that resulted in an unexpected outcome and ended with a member saying, “I wish I would have called Practice Support before I …” Included are links to relevant articles offering explanations and helpful resources.
California-contracted dentists should prepare for a quality assessment review, says Delta Dental
05/14/2019
Delta Dental of California notified California dentists in its FYI newsletter that dentists should be prepared for a quality assessment review. CDA members are encouraged to review the on-site QA review checklist provided in the April 9 newsletter to ensure compliance. 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.
New online form available for reporting dental benefits plan issues
04/25/2019
CDA Practice Support introduces a new, secure online submission process for dentists to use to report issues with dental benefits plans. By streamlining the intake process, this form will make it easier for practicing dentists to quickly reach out for assistance and submit issues at their own convenience. To receive assistance, simply submit your issue electronically using the new submission form available online within your cda.org account.
Network leasing bill gains traction, adds protection for dentists, patients
04/16/2019
AB 954, authored by Assemblymember Jim Wood, DDS, and sponsored by CDA, unanimously passed the Assembly Health Committee April 3 with favorable amendments to further protect dentists and patients when dental provider agreements are leased by third parties. The bill was introduced to make the network leasing process more transparent. Currently, dentists are not always aware that their existing contract with a health care benefit plan will be transferred or sold as part of a leased network.
Bill sponsored by CDA protects dentists during network leasing
04/03/2019
Moving through the state Legislature is a CDA-sponsored bill that, if signed into law, will bring more transparency to network leasing by dental benefit plans — a process that often leaves dentists and their patients in the dark. The growing trend of network leasing is causing confusion and difficulties for California dentists and their patients.
Billing dentists: Learn how to properly bill when another dentist performs treatment
03/28/2019
Many dental benefit plans have adopted contracting based on the contract of the treating dentist, not just the billing (owner) dentist. When billing a benefit plan, the information documented on the claim in the billing dentist or billing entity, treating dentist and treatment location sections must all be accurate. If the treating dentist documented on the claim differs from the treating dentist noted in the patient’s chart, it’s considered to be fraudulent billing.
Statewide conference in May focuses on future of health care delivery in California
03/18/2019
Dentists and other health care providers are encouraged to attend Health Information Technology After Meaningful Use — a statewide conference happening May 13 in Sacramento and hosted by CalHIPSO, an organization formed through a partnership of the California Medical Association, the California Primary Care Association and the California Association of Public Hospitals and Health Systems.
Improper billing during practice transitions is risky business
01/30/2019
As the dental benefits analyst for CDA Practice Support, my job is to help dentists navigate the ever-changing dental benefits marketplace, and this entails clearing up misconceptions that could place a dentist at risk. In my conversations with dentists who are selling or buying a practice, I’ve found some misconceptions concerning billing dental benefit plans following the sale of a practice.
In-office discount plans: Legal requirements and other considerations
01/03/2019
In a dental economy dominated by PPOs, dentists are looking for ways to encourage patients, particularly those with limited coverage or no coverage at all, to seek the care they need. According to the ADA, access to dental insurance is the No. 1 predictor of a dental visit due to the patient’s ability to offset their out-of-pocket expense for oral health care.
CDA offers help with dental benefits for dentists - and their staff
12/03/2018
Navigating the ever-changing dental benefit marketplace can be a full-time job. CDA member dentists may already know that dental benefit assistance is available to them through CDA Practice Support. However, dentists may find it hard to break away from dentistry to reach out for assistance. Conveniently, dental office staff are welcome to ask Practice Support questions on dentists’ behalf.
Quick overview of CDA’s Dental Benefit Plan Handbook
11/20/2018
CDA Practice Support recently revised the Dental Benefit Plan Handbook. Much the way that a full breakdown of benefits gives the office and patient a comprehensive look into policy benefits, limitations and exclusions, the Dental Benefit Plan Handbook provides a full breakdown of the dental benefits marketplace for practice owners and their staff. The handbook’s 11 chapters cover industry standards, unique policy differences, laws and ethics.
New Delta Dental rule can affect dentists' fees
11/13/2018
CDA Practice Support continues to receive calls from member dentists regarding Delta Dental of California’s recently implemented contractual change under Participating Dentist Rule 2, Basis of Fees. In a letter mailed to participating providers in January, Delta Dental of California shared revisions to its provider participation documents. Specifically, Appendix A – California Participating Dentist Rule 2 — was revised.
CDT 2019 dental code additions, revisions and deletions announced
11/08/2018
Every year, CDA encourages all dentists to prepare for dental code additions, revisions and deletions. The ADA has released the CDT 2019 with 15 additions, five revisions and four deletions that will go into effect Jan. 1. It is recommended that all dental offices have a current copy of the CDT to assist with proper claim billing. Typically, plans will start sending updates about policy changes for the new year during the fourth quarter.
Legislative victory: Dental Plan Transparency Act passes
10/08/2018

CDA’s sponsored legislation calling for more value and transparency from dental plans passed the California Legislature with bipartisan support and was signed by Gov. Jerry Brown on Sept. 29. CDA and the author of SB 1008, Sen. Nancy Skinner, worked closely with stakeholders to ensure the best outcome for CDA members and consumers in California — increased transparency, accountability and value from dental benefit plans.

Is it a covered benefit? Understanding the noncovered services law
09/26/2018
A common question received by Practice Support is whether a dental plan that a dentist is in contract with can dictate fees on procedures that the policy does not cover. What CDA members specifically want to know is what the dentist can charge the patient. I wish I could provide a simple answer, but the simple truth is that there is very little that is simple about the dental benefit marketplace.
Legislation, report highlight need for dental plan transparency
09/04/2018
A CDA-sponsored bill requiring standardized disclosures from dental plans is headed to the governor’s desk as a new journal paper highlights the need to establish greater transparency from dental plans to protect consumers. The paper, based on a CDA-commissioned report, makes the case for a minimum dental loss ratio. Currently, no minimum standard exists for dental plans to spend a certain percentage of patient premiums directly on patient care.
Provider dispute process offers fair, fast and cost-effective resolution
08/23/2018
Simply asking a plan to reconsider a decision does not initiate the provider dispute mechanism. A request made by phone call or email or otherwise not made according to the plan’s established procedure will be treated as an informal appeal, which should be used only once. If it does not result in resolution, the dentist should file an appeal through the provider dispute resolution process established by the dental plan.
Free lectures at The Spot cover regulatory compliance, employment law and more
08/14/2018
This September at CDA Presents The Art and Science of Dentistry in San Francisco, The Spot Educational Theater will host free one-hour lectures nearly every hour on the hour beginning at 10 a.m. all three days of the convention. Among the scheduled lecturers are CDA Practice Support’s four analysts who provide expert guidance in the areas of dental benefits, employment practices, practice management and regulatory compliance.
Uptick in Quality Assessment audits by Delta Dental of California
07/17/2018
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. Delta Dental of California notified California dentists in its summer 2018 FYI newsletter that dentists should be prepared for a Quality Assessment review.
When refund demands follow audits by third-party payers
07/12/2018
In “Understanding audit authority of third-party payers,” Cindy Hartwell, dental benefits analyst at CDA Practice Support, explained how a dental benefit plan’s authority to audit charts and records is a very important if often overlooked component of contracting with a dental benefit plan. In this article, she discusses what happens when the plan’s findings from the audit result in a refund demand.
Bill to increase dental plan transparency clears Senate with bipartisan support
06/18/2018
CDA-sponsored Senate Bill 1008 (Skinner, D-Berkeley), which calls for more value and transparency from dental plans, is moving swiftly through the Legislature. The bill in late May passed the Senate with bipartisan support despite strong opposition from the dental plan lobby. SB 1008 supports patient choice of provider and helps level the playing field for providers and patients.
Experts help CDA members navigate the business side of dentistry
06/14/2018
Four experienced CDA Practice Support analysts are available to assist members with matters related to dental benefit plans, employment law and human resources, regulatory compliance and practice management. These specialized experts provide one-on-one guidance by email and phone and speak on timely topics at CDA’s biannual education convention. Together they’ve developed a full library of online resources that they expand upon and update throughout the year.
Understanding audit authority of third-party payers
05/08/2018
An often overlooked but very important component of contracting with a dental benefit plan is the plan’s authority to audit charts or records. State regulators require dental benefit plans to have quality management, utilization and antifraud policies and procedures in place to protect the insured. Performing these post-pay chart audits or reviews is one way plans comply with this requirement. They conduct these reviews to ensure that dental procedures reported by a dental office on behalf of an enrollee are consistent within the provisions of the dental benefits.
Dental benefit contracting: It’s not all about the fees
04/10/2018
I’ve heard from some dentists who signed on to a plan’s network only to discover afterward that the plan has certain policies and procedures that the dentist disagrees with. It appears, then, that the advice “buyer beware” also applies to one considering “buying” into a provider network. Many of the complaints CDA Practice Support hears from dentists are about plan payment policies that are often spelled out in the provider contract or handbook, so a thorough review of a plan’s provider contract prior to signing is strongly recommended.
CDA legislation calls for more value, transparency, from dental plans
03/21/2018
New legislation sponsored by CDA and introduced by Sen. Nancy Skinner (D-Berkeley) is working to increase value and transparency of dental benefit plans. Senate Bill 1008 calls for the establishment of a minimum dental loss ratio for individual, small and large group dental benefit products and requires increased transparency for consumers who purchase dental savings or dental discount products by requiring standardized disclosures of what a dental benefit plan does or does not provide.
Prevent billing problems — and stress — during leaves of absence
03/13/2018
Some events in life, such as the birth of a child or certain medical procedures, can be planned or controlled. But there are times when circumstances are outside of our control, such as with injury or unexpected death. In this article, we address how your absence in the practice could result in dental claim processing issues and how having a plan of action in place can reduce complications during these times.
Dental plan correspondence — it’s not all junk mail
02/28/2018
In today’s world, we are often bombarded with junk mail, making it easier to overlook an important notice from a benefit plan that could upset the way a dental practice does business. This is why it is essential for an office to establish a protocol for reviewing benefit plan mailers in a timely manner.
Hang up and log in for dental plan benefit information
01/31/2018
Benefit plans have started offering information through their own online portals. When these portals were first introduced, the information offered was insufficient at best and in most cases still required an office to call the plan with many unanswered questions. However, this is less the case today as many plans have worked to improve their portal functionality to better meet the needs of the dental community.
If I had a magic wand: Reflections on managing dental benefit issues
11/20/2017
Greg Alterton is approaching his 16-year anniversary with CDA. He worked in the CDA Public Policy Division for 13 of those 16 years, where he was involved in developing dental benefits legislation sponsored by CDA. He has assisted individual members directly with their dental benefit issues while in Public Policy and during the past three years with CDA Practice Support. He retires from CDA at the end of 2017.
Prepare for CDT 2018 dental code additions, revisions and deletions
11/15/2017
CDA encourages all dentists to prepare for CDT 2018 dental code additions, revisions and deletions that go into effect Jan. 1, 2018. The new year will bring 18 new procedure codes, 16 revisions and three deletions. While dental plans are required to recognize current CDT codes, it is important to keep in mind that they are not required to pay for or provide benefits for the new or revised codes. Dentists should review each dental plan’s payment and processing guidelines to determine whether benefits will be payable.
Billing during practice transitions: Correcting the myths
10/19/2017
Myth busting: It’s part of what we do. And circulating out there are a number of myths regarding how dental plans should be billed when a practice is in the midst of transferring ownership.
CDA addresses questions about changes in provider contracting
09/11/2017
Have you ever had one of those moments when you received a decision from a dental benefit plan and thought, “There ought to be a law?” Well, there isn’t a law, in many cases. All health plans must meet requirements as determined by the state agencies that regulate, license and certify them. However, the issues that matter most to providers as well as patients — what is included in the plan’s scope of benefits, for example — are not governed by state laws or regulations.
Calling benefit plans for resolution or spinning your wheels?
08/02/2017
There’s a reasonable assumption that calling a dental plan about a payment dispute will resolve the dispute. We’d all like to think this works more often than it actually does, but the reality is that informal calls to dental plans about payment or other issues the dental practice is having with a dental plan may not quickly lead to resolution.
Dental Benefits 101: Preauthorization versus predetermination
07/05/2017
CDA Practice Support occasionally hears a complaint from dental offices that a plan granted a preauthorization for treatment and then denied payment when the claim was submitted. Digging a little deeper into these complaints, there may be some confusion between what constitutes a “preauthorization” and what is a “predetermination” or pre-estimate of benefits.
Medicare opt-out excludes Medicare Advantage
05/23/2017
As most know, the Affordable Care Act of 2010 allows nonphysician health care providers to enroll as providers in the Medicare program or, alternatively, to formally opt out of Medicare. Most dentists have chosen to opt out of Medicare, but there’s another Medicare category that dentists should consider: Registering with Medicare as an Ordering and Referring provider.
Get answers from Practice Support experts at CDA Presents
04/14/2017
Addressing patients’ clinical needs is what every dentist is taught in dental school. What a dentist is not taught is how to run a small business with employees and how to navigate patients’ benefit plans. CDA Practice Support experts will be on-site at CDA Presents Anaheim, at the Member Benefits Center, to answer members’ questions about dental benefits, employment and regulatory issues. Additionally, each expert will present a free one-hour lecture at The Spot Educational Theater. Topics include the dental benefits grievance process, HIPAA compliance essentials and lesser known employment laws.
Responding to dental plans' retroactive refund demands
03/28/2017
Demands from dental plans seeking refunds of previously paid claims are common, but they’re not all alike. Most refund demands are legitimate, and state law requires health care providers who have been overpaid to refund an overpayment within 30 days of notice. These overpayments typically result from plans paying on claims when the patient had fallen out of eligibility unbeknownst to the plan when payment was made. Other overpayments may result from mistakes of the dental plan or insurer itself.
Medicare Part D enrollment, opt-out deadline extension
02/16/2017
CDA reminds dentists that the Centers for Medicare and Medicaid Services last October moved the Medicare Part D enrollment deadline from Feb. 1, 2017, to Jan. 1, 2019. Dentists should either enroll as a Medicare Part D "ordering/referring provider" or opt out of the Medicare program entirely by the January 2019 deadline.
Understanding dental plan audit authority
02/01/2017
The new Congress and administration in Washington are negotiating legislation that would considerably dismantle the Affordable Care Act as one of their first objectives. While it remains to be seen what this repeal and replacement of the ACA will look like, one aspect of the ACA that will likely survive is the idea and objective of “affordable” health care.
Final notice: Sending an account to collections
01/23/2017
Collections is one of the most crucial and challenging aspects of practice management. Using a collections protocol is a basic first step in addressing unpaid balances, but if phone calls and letters go unanswered, a dentist is faced with the dilemma of whether to turn the account over to a collection agency. TDIC advises dentists to carefully consider the pros and cons of such an action.
Dental benefits 101: Proper billing, waiving co-payments
12/21/2016
Beginning in the New Year, and with the forthcoming issue of the CDA Update, the dental benefits column will host a semiregular series discussing basic dental benefit issues. The topics covered address questions that CDA Practice Support receives from dental offices and from local dental components. This first installment addresses proper billing for treatment provided by an associate and waiving of co-payments.
Medicare Part D enrollment deadline now January 2019
11/17/2016
The Centers for Medicare and Medicaid Services has again extended the deadline for dentists to either enroll as a Medicare Part D "ordering/referring provider" or opt out of the Medicare program entirely. The previous deadline was Feb. 1, 2017, but it has now been extended to Jan. 1, 2019.
CDT 2017 dental code changes are here
11/16/2016
CDT 2017 is the newest version of the American Dental Association’s code on dental procedures and nomenclature. Dentists will need to prepare for the 2017 dental code changes effective Jan. 1, 2017. CDA is happy to see the addition of D4346: Scaling in presence of generalized moderate or severe gingival inflammation.
Dentists should respond to dental plan verifications
11/01/2016
Under SB 137, which went into effect July 1, dentists contracted with dental plans must respond to a plan’s request for accurate directory information within 30 days or face payment delays, reimbursement reductions or termination of their participating provider agreement.
How to bill for noncovered procedures
10/24/2016
Recently, Practice Support has received questions about whether the dental plans that dentists are contracted with can dictate fees for treatment on procedures that the plans don’t cover. The answer can be found in CDA-sponsored legislation that became effective in 2011.
Federal Employee Program Payment challenges continue
10/20/2016
Over the past year, CDA has received phone calls from member dentists about dental claim payment issues with the Blue Shield of California Federal Employee Program. CDA reached out to Blue Shield of California to obtain information and seek a resolution that ensures more timely payment for dentists who treat federal employees.
Top trending CDA Practice Support resources
10/11/2016
Here are the top-five trending CDA Practice Support resources in the categories of practice management, employment practices, dental benefit plans and regulatory compliance.
Delta's Medicare requirement won't apply in California
09/28/2016
Recent contractual amendments made by Delta Dental of Michigan, Ohio and Indiana effective Jan. 1, 2017, state that dentists who chose to opt out of Medicare Part D in these three states will no longer be eligible to remain Delta Dental network providers. Delta Dental of California verified that it is not adopting the same policy.
How to contract with and bill for associates
09/22/2016
As the dental marketplace continues to change, hiring associates and having a multidentist practice is increasingly more common. CDA Practice Support frequently receives inquiries from members regarding how to correctly bill for associate dentists providing treatment in their practice.
Top trending CDA Practice Support resources
09/13/2016
Here are the top five trending CDA Practice Support resources in the categories of practice management, employment practices, dental benefit plans and regulatory compliance: housekeeping schedule; reclassification of exempt employees; sample patient appreciation letters; dealing with refund demands; and Cal/OSHA training requirements.
New balance billing legislation addresses CDA concerns
09/05/2016
AB 72 furthers consumer protections while also making it easier for physicians to resolve reimbursement problems with insurers. Under this bill, out-of-network physicians providing treatment at an in-network hospital or clinic must receive a patient’s voluntary consent to be treated for out-of-network care at least one day before the treatment.
Understanding utilization review and audits by benefit plans
08/17/2016
As part of a contractual commitment the dental benefit plans have with their consumers (employer groups and their employees), the plans are required to have a claims utilization review and audit process.
Provider directory compliance letters in the mail
08/16/2016
Delta Dental has initiated the first of a three-phase mailing to participating dentists as part of the provider directory verification process required by California Senate Bill 137.
Join conversations on dental benefits at CDA Presents
08/12/2016
At the 2016 CDA Presents The Art and Science of Dentistry in San Francisco, CDA will engage in conversation with representatives of the dental benefits industry about the likely future direction of dental benefits, the payment policies that challenge dental practices today and the practical approaches in the dental office to successfully administer patients’ dental benefits.
Provider directory law in effect Friday
06/29/2016
Effective July 1, a new law requires dental plans to comply with uniform standards and provide timely updates — including changes in practice address, license number, etc. — to their provider directories. The intent of the new law, SB 137, is to provide patients with more accurate and complete information regarding providers participating in the plan’s provider network.
Dental plans moving to direct deposit claim payments
06/27/2016
The dental plan industry reports that more than 70 percent of dental claims received by plans are sent electronically. In California, that number is closer to 75 percent. Practice management software, and the standardization of forms for electronic transactions, have made this possible.
Top trending CDA Practice Support resources
06/24/2016

CDA Practice Support is designed to help dentists navigate the business side of dentistry with ease, and it is chock-full of valuable resources to help them run their practices. Check out the top five trending CDA Practice Support resources in the categories of practice management, employment practices, dental benefit plans and regulatory compliance.

Know your numbers to ensure provider directory compliance
06/13/2016
SB 137 requires dental plans to comply with uniform standards and provide timely updates for their provider directories and there are two numbers you need to know to ensure compliance with the new law that goes into effect July 1 — 30 and five. The goal of this legislation and resulting regulations is to provide patients with more accurate information to identify which dentists are participating with their dental plan.
Billing medical plans for dental treatment
05/25/2016
There is an ongoing trend within health care toward integration and consolidation of health care delivery systems. This trend is reflected in provisions of the federal Affordable Care Act, such as the envisioned coordination of care provided under a single entity, the “Accountable Care Organization.”
New law requires accurate dental plan provider directories
05/03/2016
A law created by Senate Bill 137 goes into effect on July 1 and requires all health plans to maintain accurate provider directories. This law requires dentists contracted with dental plans to respond to a plan’s request for accurate directory information within 30 days or face payment delays, reimbursement reductions or, ultimately, termination of their participating provider agreement.
Dentists must give timely practice updates
04/06/2016
Beginning July 1, a new law will take effect requiring dental plans to comply with uniform standards and provide timely updates (practice address, license number, etc.) to their provider directories. The intent of the new law, SB 137, is to provide patients with more accurate and complete information as to which providers are participating in the plan's provider network.
Deadline for Medicare registration extended
03/14/2016
The Centers for Medicare and Medicaid Services has extended the deadline for dentists to either enroll as a Medicare Part D "ordering/referring provider" or opt out of the Medicare program entirely. The previous deadline was June 1, but it has now been extended to Feb. 1, 2017.
Registration for 2016 Dental Benefits Workshop now open
02/23/2016
Navigating the dynamic world of dental benefits can be a challenge for some dental practices. That is why CDA is pleased to announce registration is open at cda.org/dbw for the 2016 Dental Benefits Workshop in Sacramento on June 10. The 2016 Dental Benefits Workshops offered by CDA are interactive courses focused on timely topics for which CDA receives a high volume of inquiries.
The correct way to bill for associate dentists
12/21/2015
As the dental marketplace continues to change, hiring associates and having a multi-dentist practice is increasingly more common. CDA Practice Support receives frequent inquiries from members regarding the correct way to bill for associate dentists providing treatment in their practice.
Top 10 CDA Practice Support resources in 2015
12/04/2015
CDA Practice Support is designed to help dentists navigate the business side of dentistry with ease, and it is chock-full of valuable resources to help them run their practices. Here are the top 10 CDA Practice Support resources of 2015 in the categories of practice management, employment practices, dental benefit plans and regulatory compliance.
Dentists should choose their Medicare status now
11/24/2015
Medicare has given dentists and other health care providers until June 1, 2016, to declare whether they will opt in or opt out of the program. However, the Centers for Medicare and Medicaid Services (CMS) is encouraging providers to get their forms into the state Medicare administrator by the first of the year to assure that a provider’s status is recorded by the June 1 date, as it will take the administrators four to six months to process forms.
Adult dental now available through Covered California
11/10/2015
Covered California, California’s health insurance marketplace for the federal Affordable Care Act, is now offering family dental plans to purchase for the 2016 benefit year. The standalone family dental plans are available in addition to the children’s dental coverage included as an essential health benefit for consumers younger than 19 years old.
Shift in credit card fraud liability has occurred
11/03/2015
EMV (Europay/MasterCard/Visa) will eventually replace the magnetic stripe on credit cards that has been the standard in the United States since 1960, and dental practices should be ready for this transition. Acceptance of EMV will not technically be mandated for practices that accept credit or debit cards, but a shift in fraud liability began in October.
Answers to two common dental benefit questions
10/20/2015
CDA Practice Support receives many questions from members about dental benefits. Two of the most common questions are about patient copayments and patient discounts for prepayments. Here are answers to both.
Top CDA Practice Support resources in October
10/13/2015
CDA Practice Support is designed to help dentists navigate the business side of dentistry with ease, and it is chock-full of valuable resources to help them run their practices. Here are the top five trending CDA Practice Support resources in October in the categories of practice management, employment practices, dental benefit plans and regulatory compliance.
A dentist's rights in a dental benefit plan dispute
10/05/2015
CDA receives numerous calls daily about various disputes dentists have with patients’ dental benefit carriers. While CDA will consider how these disputes might be informally resolved, ultimately, the dentist has the right to appeal the dispute back to the plan, and eventually with the plan’s regulator.
CDA provides answers to X-ray policy changes
09/22/2015
United Concordia changed how periapical X-rays would be paid this summer and CDA Practice Support, after receiving calls from members about the changes, reached out to the company on behalf of dentists to get additional information. Here are the aspects of the new policy that CDA has learned from its correspondence with the insurance company.
Dentists should prepare for 2016 dental code changes
09/21/2015
The ADA has released a resource that provides updated information to dentists on all of the latest dental code changes that will go into effect on Jan. 1. CDT 2016 provides accurate and up-to-date ADA dental procedure codes. Dentists who rely on old information may experience unexpected claim denials or reimbursement delays. Code changes for 2016 include 19 new codes, 12 revised codes and eight deleted codes.
Top trending CDA Practice Support resources
09/14/2015
CDA Practice Support is designed to help dentists navigate the business side of dentistry with ease, and it is chock-full of valuable resources to help them run their practices. Here are the top five trending CDA Practice Support resources in the categories of practice management, employment practices, dental benefit plans and regulatory compliance.
Diagnostic code changes approaching
09/07/2015
The Centers for Medicare and Medicaid Services (CMS) has set the implementation date of the International Classification of Diseases version 10 Clinical Modification (ICD-10 CM) for Oct. 1. While the implementation of ICD-10 CM affects a limited number of dentists in California, such as oral surgeons, anesthesiologists, pathologists, etc., it is important to note that all dentists should be aware that diagnostic coding could become a requirement in the future.
Top 5 CDA Practice Support resources in August
08/13/2015
CDA Practice Support is designed to help dentists navigate the business side of dentistry with ease, and it is chock-full of valuable resources to help them run their practices. Here are the top five trending CDA Practice Support resources in the categories of practice management, employment practices, dental benefit plans and regulatory compliance.
California making strides in dental care measurement
08/11/2015
As the dental insurance marketplace continues to increase focus on improved quality of care, accountability and value, California’s Health Benefit Exchange (Covered California) has taken the first steps in further ensuring Californians receive quality dental care. Specifically, it has announced that it will require all dental plans offering coverage through the Exchange to adopt the Dental Quality Alliance’s (DQA) Pediatric Quality Measures Set.
What to expect during a dental plan utilization review
08/10/2015
As part of a contractual commitment the dental benefit plans have with their consumers (employer groups and their employees), they are required to have a utilization review process. Recently, CDA has received an increase in calls about these types of reviews by the dental plans. Utilization review is a post-claims review process that can affect dentists who treat patients covered by a dental benefit company.
Top 5 CDA Practice Support Resources in July
07/20/2015
CDA Practice Support is designed to help dentists navigate the business side of dentistry with ease, as it is chock-full of valuable resources to help them run their practices. Here are the top five trending CDA Practice Support resources this month in the categories of practice management, employment practices, dental benefit plans and regulatory compliance.
The top reasons for claim denials
07/10/2015
Medical/dental necessity will always be the rationale for most dental care, but medical/dental necessity may not be the basis of how plans pay. Dentists often wonder what the top reasons are for claims being denied. Here are some simple reasons why.
Top 5 CDA Practice Support Resources in June
06/19/2015
CDA Practice Support is designed to help dentists navigate the business side of dentistry with ease, as it is chock-full of valuable resources to help them run their practices. Here are the top five trending CDA Practice Support resources this month in the categories of practice management, employment practices, dental benefit plans and regulatory compliance.
Register for Dental Benefits Workshop in Irvine
06/18/2015
Navigating the dynamic world of dental benefits is key to managing a smart practice. The Dental Benefits Workshop provides participants the opportunity to earn 12 C.E. credits during a two-day, in-person seminar. They will learn how to analyze and evaluate existing dental plan performance in their offices while getting hands-on experience from industry experts on how to navigate the world of dental benefits.
Member benefit supports practices' business side
06/16/2015
Mireya Ortega, DDS, thought she had taken all of the necessary steps in the insurance approval and billing process for her patient. But despite doing everything according to the insurance policy standard she was sent a letter in the mail informing her she needed to return all of the money she had received for the treatment because the patient in fact did not have coverage. That is when she called CDA Practice Support.
Medicare provider enrollment date pushed back again
06/15/2015
The federal Centers for Medicare and Medicaid Services (CMS) has again changed the compliance date for dentists desiring to opt out of the Medicare program. The new date, June 1, 2016, comes some two weeks after CMS moved the date from June 1 of this year to Jan. 1 of next year.
Top 5 CDA Practice Support Resources in May
05/21/2015
CDA Practice Support is designed to help dentists navigate the business side of dentistry with ease, as it is chock-full of valuable resources to help them run their practices. Here are the top five trending CDA Practice Support resources this month in the categories of practice management, employment practices, dental benefit plans and regulatory compliance.
Changes in enrollment deadline for Medicare
05/18/2015
The Centers for Medicare and Medicaid Services (CMS) has announced that the new compliance date for enrollment or opt out for dentists to the Medicare program is Jan. 1, 2016. The original deadline was June 1. Dentists are encouraged to consider June 1 as a soft compliance date to get their forms in so as not to have their status or patient benefits lapse while forms are being processed.
Dentists get dental benefits lesson at CDA workshop
05/13/2015
Attendees of CDA’s recent Dental Benefits Workshop at the CDA headquarters in Sacramento had the opportunity to earn C.E. credits while learning how to analyze and evaluate existing dental plan contract performance in their practices.  The more than 70 people, including dentists and staff from 40 practices, who attended the April 16-17 event earned up to 12 hours of C.E. and improved their skills in analyzing and evaluating the dental benefit marketplace.
Health payers switch to new diagnostic codes this year
04/30/2015
Increasingly, dental plans are deferring to medical benefit carriers on certain dental procedures that can be claimed as medical procedures with patients’ medical plans. More and more, these medical plans are paying for not only surgical dental procedures, but some preventive dental services as well. In submitting claims to medical plans, dentists need to be aware of and prepare for the adoption of new medical diagnostic codes that will be in use beginning Oct. 1.
Top 5 trending CDA Practice Support resources
04/24/2015
CDA Practice Support is designed to help dentists navigate the business side of dentistry with ease as it is chock-full of valuable resources to help them run their practices. Here are the top five trending CDA Practice Support resources this month in the categories of practice management, employment practices, dental benefit plans and regulatory compliance.
What to consider when offering discount dental plans
03/23/2015
As the Affordable Care Act continues to change the health care landscape, one option that has emerged for dentists is to make care available to patients using a discount dental plan. Discount dental plans operate much like Costco or other large membership retailers: a membership fee is charged for the ability to purchase services at a discount below the standard customary fees charged for dental care.
Whether to opt in or out as a Medicare provider
02/16/2015
A requirement dentists need to keep in mind this year is the designation of their status with the Medicare program. CDA is receiving an increasing number of inquiries about what to consider when choosing your status. Conversations with the ADA and the Medicare administrator for California indicate that additional information, and reminders about the requirement, will be needed as the deadline nears.
Dental benefits education pays off for practices
12/10/2014
In March 2014, CDA piloted the Dental Benefits Workshop, a two-day program for dentists that provided the necessary tools and insight into the challenging world of dental benefit plans. In attendance were 40 dentists who were hand-selected to participate in the pilot program based on several criteria, including number of years in practice, current participation level with dental benefit plans, practice demographics, etc. A six-month post-workshop survey of the March 2014 workshop attendees showed decreased claim denials and improved patient communication, among other things.
Register for 2015 Dental Benefits Workshops
10/15/2014
Registration for CDA’s 2015 Dental Benefits Workshops is now open. The Dental Benefits Workshop provides dentists the opportunity to earn C.E. credits during a two-day, in-person seminar where they will learn how to analyze and evaluate existing dental plan contract performance in their practices. The seminars will be held at CDA headquarters in Sacramento and in Irvine in 2015. Registration is now open at cda.org/dbw.
Deadline to opt in/out as Medicare provider
10/02/2014
There are two important reasons why dentists need to pay attention to upcoming changes and understand the potential impact to dental patients and one's dental practice. First, with 35,000 licensed dentists in California and more than 5 million Californians enrolled in Medicare, simple arithmetic shows that there are 143 Medicare patients per dentist in the state. Secondly, CMS issued a recent rule requiring all physicians and eligible professionals — including dentists — who prescribe Part D-covered drugs to be enrolled in Medicare or opt out for those prescriptions to be covered under Part D by June 1, 2015.
07/25/2014
With more than 700 dentists graduating from California dental schools recently, there is a wave of newly licensed professionals surfing the web and hitting the streets in search of job opportunities as associates in dental practices around the state. Simultaneously, more experienced CDA members may be expanding their practices by bringing in associate dentists as part of their long-term strategic plan. The issues surrounding dental benefit plan billing can become more confusing for the dentist(s) and office teams due to the new addition of a dentist to a practice.
CDA provides guidance on navigating Adult Denti-Cal
07/07/2014
Although federally required adult dental services have been available to beneficiaries of Medi-Cal, adult optional Medi-Cal dental benefits were eliminated in July 2009, except for beneficiaries who are pregnant or residing in a skilled nursing facility or intermediate care facility. With many benefits for adults restored May 1, the recent CDA Presents lecture in Anaheim titled Adult Denti-Cal Services: Navigating the Renewal Program explained the treatment options and requirements of newly reestablished Denti-Cal benefits for adults. Presenters Tom Holloway, DDS, Nagaraja Murthy, DDS, and Nirmala Prabhu, DMD, offered valuable information concerning common denial codes in treatment authorization requests and claims, ways to reduce unnecessary denials and specific criteria for common restored procedures.
05/08/2014
CDA receives calls regularly from dentists about claims payments as it relates to dental benefit plans. CDA dental benefits analyst Ann Milar discusses some of the issues in this area that dentists run into and what dental plans can do. Specifically, Milar suggests if a dentist is a contracted, participating provider for a dental plan, they should have a provider handbook or manual that outlines the plan’s payment and processing guidelines. Most dental plan provider contracts require that the provider understand these guidelines.
02/07/2014
CDA receives thousands of member calls each year on the four major topic areas of a dental practice: dental benefits, employment, practice management and regulatory compliance. Dental benefits receives more than 3,000 calls per year, and of those calls, approximately half of them are related to a dental plan not doing what the dentist (and their staff) expected.
01/31/2014
At the beginning of the year, a few hundred dentists received a letter or telephone call from a dental plan indicating that they had been selected for a quality assurance audit. A CDA dental benefits analyst addresses some common dentist questions related to this and offers a few suggestions for navigating the audit process.
01/23/2014
CDA has learned that United Concordia plans to adjust reimbursement rates for its National Fee for Service Maximum Allowable Charge (MAC) schedule. United Concordia has sent letters to approximately 5,000 contracted providers in California impacted by this action. Providers in other United Concordia networks are not affected by these changes.
11/25/2013
A lot has happened in the world of dental benefits this year. As the holidays approach and the year comes to a close, CDA Dental Benefits Analyst Ann Milar takes a look back at 2013 and what is ahead in 2014.
09/17/2013
As a new crop of licensed dentists take the next steps in their dental careers this fall, there will be a host of new experiences ahead, including dealing firsthand with dental benefit plans. In order to gain a better understanding of what new dentists need to know about dental benefit plan issues, CDA reached out to three dentists who have less than five years of experience.
08/30/2013
Dental plans send mail to providers for many reasons and it is important to have an office protocol for reviewing this correspondence to protect you from changes that you may later find affect your practice. This article provides one example of a dentist not being aware of an opt-out notice.
05/10/2013
As part of an effort to simplify providers’ participation in the state’s Medi-Cal Dental Benefits Program (Denti-Cal), CDA, with the cooperation of the State Department of Health Care Services’ Dental Services Department, has developed a guide to working within the program. The guide, entitled “Denti-Cal Provider Guide,” is divided into two main sections:  Processing a Denti-Cal Patient Through the Dental Practice; and the Denti-Cal Billing Process.
04/08/2013
CDA continues to advocate on behalf of its’ members concerning Delta Dental’s intention to cut Premier Plan provider reimbursement rates an expected average of 8 to 12 percent later this year. The following letter from CDA President Lindsey Robinson, DDS, explains to members that Delta has a responsibility and an obligation to communicate with its providers when inquiries are made, not limited to the legally required 45-day contract policy notice period, and failure to do so can result in providers filing complaints. The letter is as follows:
03/22/2013
Since learning of Delta Dental’s decision to cut fees an expected average of 8 to 12 percent for its Premier product, CDA has pressed Delta for more specific details about the impending fee reduction. We have compiled a list to inform members about what we currently know. CDA will continue to provide information as soon as possible to keep members informed.
03/04/2013
In a letter from CDA President Lindsey Robinson, DDS, the association is urging Delta Dental to communicate answers to providers about its impending rate reduction. Dr. Robinson’s message to members and the letter to Delta are posted here.
02/20/2013
CDA is providing members with the latest information and resources after learning that Delta Dental intends to reduce provider reimbursement rates in its Premier Plan later this year.
02/11/2013
CDA offers resources and answers to member questions in a letter from CDA President Lindsey Robinson, DDS.
02/01/2013
CDA has learned that Delta Dental is planning to reduce reimbursement to its Premier Providers. We are now in contact with Delta to obtain details and clarification about this decision. It is likely these reductions will average 8 to 12 percent and may vary by region and provider. The reason for the reductions is not yet clear, but it is likely to be market pressures and a resultant effort to reduce the cost of the Premier plan for employers in order to keep it viable. The reductions will not go into effect immediately, but are intended to be implemented later this year.
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