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Finance & Billing

Know how to handle dental plan claims and payments and track COVID-related expenses for your practice.

Prepping for Dental Plan Payments

May 06, 2020 3044

Steps to transition, improve claim submission & payments.

As you prepare to return to regular practice, take these actions now for a smooth transition and improvement to overall claims submission and dental plan payments.

Sign up for access to dental plans’ online portals.

As employees transition back to work, dental plans may be short staffed, which could lead to an increase in call hold times. However, many dental plans’ online portals provide access to enrollees’ eligibility, benefits, treatment history, frequencies, remaining maximums and deductibles. Information about online portals can be found in the provider/dentist section of the dental plan’s website.

Go electronic for faster claims processing.

Dental plan portals have features to transmit claims and predeterminations free of charge, and the direct connection to the dental plan’s processing system expedites claims processing and payment in most cases. It is likely a dental office could submit a claim via a dental plan portal and receive payment within the same week. Information about these portals can be found in the provider/dentist section of the plan’s website.

Expedite reimbursement by enrolling in electronic funds transfer.

Electronic funds transfer is another way a dental practice can expedite reimbursement. EFT allows a plan to transfer funds for claims payment, but it does not authorize the dental plan to recoup funds from a dental practice bank account in the event of an overpayment. EFT is a one-way transaction, and the plans can only deposit, not withdraw, funds.

Conduct a practice management audit.

CDA Practice Support’s resource Conducting a Self-Audit walks dentists through how to review the practice’s strategic plan, production goals, revisions to patient scheduling, chart audit, financial audit and billing as well as how to update management policies and procedures.

Additional resources from Practice Support

In addition to a self-audit, consider these questions and use additional CDA Practice Support resources for ensuring your efficiency in billing and payments:

Is your record-keeping in the shape it should be?

 

Are you considering contracting with a dental benefit plan?

 

Are you reevaluating your current dental plan contracts?

 

Are you dealing with claim denials? Use your rights and file a provider dispute with the plan.

 

Both the California Health and Safety Code (Sec. 1371.38) affecting all Knox-Keene plans and the Insurance Code (Sec. 10123.137) affecting PPOs and indemnity insurance require plans to have in place a process for resolving provider payment disputes.

Remember: Dental benefits help is just a click away

CDA Practice Support is here to answer your dental benefit plan questions and offer one-on-one assistance to members. Use our easy online dental benefit issue submission form. Once received, Practice Support will analyze the issue, evaluate it for possible resolution and communicate clear next steps.

To get started:

  • Log in to your cda.org account and visit the My Account section
  • Click the link for Dental Benefits Issue Submission
  • Follow the prompts