Masking requirement continues in California health care settings.
See the latest
Do you have a question about a dental benefit issue? You can receive timely assistance from a CDA Practice Support expert. Simply submit your question online using the dental submission form available within your cda.org account.
Cindy Hartwell, dental benefits analyst at CDA Practice Support, reviews how a dental practice can bill properly by registering all treating dentists in the practice with the dental plan or plans.
CDA Practice Support is receiving calls from dentists and their staff concerning claim denials for scaling and root planing services by dental benefit plans. In this article, I review the criteria utilized by dental plans when reviewing claims for scaling and root planing and why some of the plan denials are correct based on the American Dental Association’s definition of scaling and root planing.
Patients with some form of dental coverage or benefit to offset their out-of-pocket cost are more likely to 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.
As California dental offices are resuming preventive care amidst the COVID-19 pandemic, the obligation to implement new safety protocols and provide additional PPE to protect staff and patients has become a financial burden.
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. 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.
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.
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.
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.