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Dentists encouraged to respond to Delta Dental recoupment demand

CDA has learned that due to a Delta Dental of California system error, crown procedure claims were erroneously processed and paid for, affecting approximately 350 self-funded employer groups between Oct. 13, 2018 and Jan. 10, 2019. The system error resulted in Delta’s payment of patient crowns prior to the five-year time limitation for crown replacement according to information Delta Dental shared with CDA.

Dentists and the affected Delta Dental enrollees have already received or will receive an “adjusted claims statement” that resembles a Notice of Payment or EOB explaining that Delta Dental has reprocessed crown procedure codes resulting in an overpayment. Statements were sent to approximately 1,000 California dentists beginning the week of Oct. 21 seeking recoupment for procedure codes D2750-D2752 and D279-D2792. The statements sent to Delta Dental enrollees include an explanation noting that the patient is responsible for payment of dental services received before the five-year time limit passed.

Dentists are encouraged to read the notice and pursue one of two courses of action:

  • Either manually refund the overpayment to Delta Dental of California and seek payment from the patient; or
  • Take action by filing a provider dispute with Delta Dental of California no later than 30 days from the date of the notice contesting the recoupment demand.

If a dentist fails to dispute the demand, Delta Dental has the right under its provider agreement to begin automatically deducting the overpaid amount from future claims payment no sooner than 45 days from the date of the notification.

Dentists needing additional CDA support or information may submit the Dental Benefit Issue Submission form available at cda.org. Just click the link to the form and follow the prompts. A Practice Support team member will reach out and offer next steps for dentists and their patients.

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