Dental Benefit Plan Handbook – Chapter 10: Understanding the Claim Appeal Process California law requires every dental plan to have a formal procedure that providers can use to dispute/challenge actions/decisions made by the plan. Overview of plan legal requirements, steps to appealing claims, filing a payment disputes. View resource Dental Benefit Plan Handbook – Chapter 10: Understanding the Claim Appeal Process
Dental Benefit Plan Handbook – Chapter 09: Managing Payment Problems Learn about your rights and actions you must take when dealing with refund demands made by dental benefit plans. View resource Dental Benefit Plan Handbook – Chapter 09: Managing Payment Problems
Dental Benefit Plan Handbook – Chapter 08: Explanation of Benefits Understand the elements of the Explanation of Benefits and what to look for. View resource Dental Benefit Plan Handbook – Chapter 08: Explanation of Benefits
Dental Benefit Plan Handbook – Chapter 07: Billing Medical Plans Learn cross-coding: billing medical insurance in a dental office; how to select the correct CPT code and ICD-10 codes when billing medical plans. View resource Dental Benefit Plan Handbook – Chapter 07: Billing Medical Plans
Dental Benefit Plan Handbook – Chapter 06: Completing and Filing the Claim Form Common reasons for claim delays and denials; correct use of procedure codes, Tax Identification (TIN) and National Provider Identification (NPI); practice’s fee schedule and radiographic image attachments; electronic claim (E-Claim) filing. View resource Dental Benefit Plan Handbook – Chapter 06: Completing and Filing the Claim Form
Dental Benefit Plan Handbook – Chapter 05: Working with Patients and Their Plans Help patients understand the relationship the practice holds with plans; overview of: in network, out of network, pre-authorization, predetermination, discounts, dual coverage and claims. View resource Dental Benefit Plan Handbook – Chapter 05: Working with Patients and Their Plans
Dental Benefit Plan Handbook – Chapter 04: Understanding Coordination of Benefits Understanding plan policies for coordinating payment of benefits when enrollees or policyholders have more than one dental benefit policy. Explanation of CA law pertaining to coordination of benefits. View resource Dental Benefit Plan Handbook – Chapter 04: Understanding Coordination of Benefits
Dental Benefit Plan Handbook – Chapter 03: Verification and Explanation of Dental Benefit Coverage Tips for verifying coverage with a patient's plan and providing explanation to help patients interpret benefits, limitations, exclusions, financial responsibility and how to maximize coverage. View resource Dental Benefit Plan Handbook – Chapter 03: Verification and Explanation of Dental Benefit Coverage
Dental Benefit Plan Handbook – Chapter 02: Understanding Dental Benefit Plan Contracts & Fees Defines the types of plans to consider for your practice, contracting & contract analysis, billing & how to establish fees and more. View resource Dental Benefit Plan Handbook – Chapter 02: Understanding Dental Benefit Plan Contracts & Fees
Dental Benefit Plan Handbook – Chapter 01: Understanding Dental Benefit Plan Coverage Overview of the types of dental coverage and the differences between dental and medical coverage, in order to aid dentists in explaining dental coverage to patients. View resource Dental Benefit Plan Handbook – Chapter 01: Understanding Dental Benefit Plan Coverage
Resources for New Dentists CDA offers a variety of tools to help you easily navigate the transition into your new profession and your early years. View resource Resources for New Dentists
Termination Checklist Requirements and best practices when separating an employee from employment. View resource Termination Checklist
Pause before you comply with a plan's request for post-payment chart review Dentists can avoid unnecessary stress by seeking guidance from CDA Practice Support before complying with a dental benefit plan’s request to conduct a post-payment chart review of patient records. View resource Pause before you comply with a plan's request for post-payment chart review
General New Hire Toolkit This toolkit covers recruiting, interviewing, hiring and onboarding, and provides a general list of basic hiring documents. View resource General New Hire Toolkit
Hiring Associates Toolkit Associates may be classified as either an independent contractor or an employee. This toolkit includes information to help you determine how to hire an associate. View resource Hiring Associates Toolkit
California Department of Managed Healthcare - Information on Provider Complaints After filing a provider dispute/complaint/appeal with a dental plan, learn how to file a 2nd level provider complaint with the California Department of Managed Healthcare. View resource California Department of Managed Healthcare - Information on Provider Complaints
Dental benefit contracting: It’s not all about the fees In this article you will learn how to weigh the costs before you sign a dental benefit participating provider agreement/contract. View resource Dental benefit contracting: It’s not all about the fees
Current CDT code books Dentistry is an ever-evolving field, and CDT codes are critical to the everyday workings of dental practices. View resource Current CDT code books
Sample Letter to Third Party Payer for Temporary Dentists This letter may be used to notify Third Party Payers when a temporary dentist will be filling in for dentist out on leave. View resource Sample Letter to Third Party Payer for Temporary Dentists
Prevent Billing Problems and Stress During Leaves of Absence Understand how a dentist's absence in the practice could result in dental claim processing issues and how to develop a plan of action to reduce complications. View resource Prevent Billing Problems and Stress During Leaves of Absence
Evaluating Dental Benefit Plans Checklist Checklist to help guide a dentist in determining if participation with a new plan fits their model/scope of dentistry, and what to review when evaluating existing plans accepted in the dentist. View resource Evaluating Dental Benefit Plans Checklist
Benefit Breakdown Form Form to aid dentists in verifying their patients' dental benefits in order to provide the best possible treatment estimate. View resource Benefit Breakdown Form
Dental Plan Questions are Attempt to Ascertain Primary Payer Clarifying dual insurance and coordination of benefits "rules" when it pertains to the children of divorced parents. What questions to ask and the "rules" surrounding who is primary and secondary. View resource Dental Plan Questions are Attempt to Ascertain Primary Payer
Delta Dental: On-site Quality Assessment Review Checklist Use this list to compare aspects of a QA review with your practice's policies and procedures, and be even better prepared for a future on-site QA review. View resource Delta Dental: On-site Quality Assessment Review Checklist
Conducting a Self-Audit Info on practice management audits: practice strategic plan, production goals and revisions to schedule, chart audit, financial audit, billing, and how to update management policies and procedures. View resource Conducting a Self-Audit