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Dental Benefits

Dental Benefits 101: Preauthorization versus predetermination

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.

Dental benefits 101: Proper billing, waiving co-payments

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.

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. 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.

Dentists receive unprecedented $30M for student loan repayment in state budget

The 2018-19 state budget signed by Gov. Jerry Brown dedicates $210 million from the Proposition 56 Tobacco Tax revenue to Denti-Cal providers, a $70 million increase from last year’s amount. This effort is the result of years of activity to improve the Medi-Cal dental program and increase access to oral health care for the state’s 13.5 million Medi-Cal enrollees.

Dentists say new process for reporting dental benefits issues is easy, convenient, fast

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.

Eligible Premier providers to receive settlement payments

Approximately 14,000 dentists are expected to receive payments by the end of October as part of CDA’s settlement agreement with Delta Dental. The agreement, which was approved by the court in May and followed by a 60-day appeal period, provides $65 million to Premier providers who had their fees impacted by Delta Dental’s “inflationary adjustment percentage.” Under the agreement, Delta Dental has 120 days from the end of the appeal period to distribute the payments to eligible providers. Dentists who did not have their fees reduced improperly by the inflationary adjustment percentage will not receive payments.

'Life-changing' grants awarded to 38 dentists committed to Medi-Cal

Marc Bernardo, DMD, MPH, and Michelle Galeon, DMD, are among the first recipients of a new grant funded by Proposition 56, a voter-approved tobacco tax that CDA and other health care organizations sponsored in 2016. The grant program awarded $10 million in debt relief to 38 dentists (up to $300,000 each) in exchange for the dentists maintaining a 30% or more Medi-Cal patient caseload for five years.

Medicare Advantage might just give your practice an advantage

With baby boomers exiting the workforce and losing their employer-sponsored dental coverage, consumers are enrolling in Medicare, the federally administered health care program for all seniors age 65 and older. Practice Support has seen an uptick in member calls related to Medicare Advantage dental plans due, in part, to the aging patient population in their practices and increased Medicare enrollment.

New CalAIM proposal by DHCS promises broad Medi-Cal reforms, adds SDF as statewide benefit

Health care providers can expect to see major revisions to the Medi-Cal program over the next couple of years as a result of a new initiative by the Department of Health Care Services. Released in late October, the California Advancing and Innovating Medi-Cal (CalAIM) proposal will implement “broader delivery system, program and payment reform across the Medi-Cal Program,” according to the proposal summary.

New law increases dental plan transparency, protects dentist-patient relationship

CDA-sponsored legislation that further increases dental plan transparency became law on Jan. 1. AB 954 requires dental plans to be more transparent about the leasing of dental networks. The new law will reduce patient and dentist confusion caused by the increasing number of plans leasing their networks to other payers, many times unbeknownst to the enrollee or contracted dentist(s). The law took effect for contracts entered into on or after Jan. 1, 2020.

No 'one size fits all' when it comes to dental benefit contracting

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.

Not your father's Medi-Cal

Improvements to the Medi-Cal Dental program continue with new options for dentists who treat Medi-Cal members, including the ability to provide fluoride treatment and fluoride varnish as a benefit once every four months for patients under age 6. The increase in the benefit periodicity underscores the state’s commitment to regular preventive oral health visits for young children in California.

Questions about coordination of benefits? CDA Practice Support has answers

CDA Practice Support receives hundreds of calls each year concerning the coordination of benefits when a patient has more than one dental plan for coverage. Standard COB allows secondary dental plans to pay up to 100% of the covered service, i.e., the primary plan pays the service at 80%, and the secondary could pick up the remaining 20%. Here, CDA’s dental benefits analyst covers the COB basics and answers common questions members have about COB.

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