Dental Benefit Plans
Communicating with patients' dental benefit providers properly is vital to most practices. Learn about your rights, how you should manage disputes and how to respond to refund demands. You'll find information on how to understand your contract, how to withdraw as a provider and much more.
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.
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.
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.
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.
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.
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.
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.
While it is only October, now is the time to begin planning to make 2014 a productive and profitable year for your practice. Having proper instrumentation is critical to practicing dentistry and providing excellent care to your patients. It is equally important that your front office staff have the right resources and tools for ensuring quick and timely payment of claims. There are hundreds of practice support resources available cda.org/compass
The registration deadline for CDA’s Dental Benefits Workshop has been extended to Nov. 15. The workshop is intended to help dentists who want to build their business skills and confidence, as well as improve practice profitability when dealing with dental plans.
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.
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.
To help improve members’ understanding of the shifting landscape of the dental benefits marketplace, CDA will host a Dental Benefits Workshop in 2014, one of several Smart Dentist Trainings offered through the CDA Practice Support Center. The extensive program will provide participants the opportunity to earn C.E. credits through a “Dental Benefits 101 Webinar” as well as a two-day, in-person seminar held at the CDA headquarters in Sacramento on March 20-21, 2014.
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.
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.
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.
CDA offers resources and answers to member questions in a letter from CDA President Lindsey Robinson, DDS.