The addition of a new or temporary dentist to a practice brings both excitement and challenges. While focusing on the seamless integration of these professionals into your practice, minimizing disruptions to the care of your patients is crucial. Many dentists understandably have questions about how the new or temporary dentist will contract with the same dental plans the owner dentist participates with. Associates also have questions about participation in dental plans. By understanding the necessary steps and adhering to best practices when informing dental benefit plans and submitting claims on behalf of the new or temporary dentist, you can optimize patient care, maintain strong relationships with dental benefit plans and streamline the administrative aspects of your dental practice.
CDA offers expertise and needed resources to ensure a smooth transition. The following frequently asked questions address key considerations, discuss common challenges and provide practical tips to minimize disruptions while upholding the highest standards of dental care.
Answer: That depends on what your intention is when the new dentist begins practicing.
If the intention is to have the new associate dentist bill for patient treatment as an out-of-network dentist, you need to notify the dental plan of the addition and provide them with the new dentist’s full name, license number and individual NPI number (also known as an NPI1).
When adding a new out-of-network associate dentist, practice owners and the new associate should be aware that:
If the intention is to have the new associate contracted with the dental benefit plan as a participating, fully credentialed dentist, more steps and information are required than if you were simply adding an out-of-network dentist. Contact the dental plan to request a new provider enrollment package and confirm the documentation needed for adding a new contracted provider.
Practice owners and the new associate should be aware that:
Answer: Credentialing and contracting a new dentist with dental benefit plans in California involves several key steps:
Answer: No. A claim form is a legal binding document, and the information reported on the claim form needs to include factual and accurate reporting of the treating dentist. Misrepresenting information on the claim form would be considered a fraudulent billing practice.
During the contracting/credentialing process, practice owners and new associate dentists should be aware that:
Answer: Although dental plan contracts are specific to individual dentists, some contracts contain portability clauses that allow the contract to be shared among locations. Possibly, a dentist has a signed contract at another location and the terms and conditions of that contract would apply at additional practice locations. Be sure to work with the associate and review the contract to verify whether the contract is portable.
Answer: CDA members can log in to access:
Answer: Under certain circumstances, dental benefit plans will allow a dentist who is not contracted with the dental plan to treat patients, submit claims and be paid as if they were a fully contracted provider as a “locum tenens” for a temporary period. Each dental benefit plan has its own policies for recognizing a locum tenens provider. In the event of a dentist’s death or incapacity, it is extremely important to contact the dental plans and request a locum tenens accommodation as soon as possible to avoid any billing issues or delay of patient care.
Some common scenarios when locum tenens may be utilized in a practice:
In the event of death or disability of a practicing dentist, California state law allows a nonlicensed, legally appointed individual to operate a dental office for a period up to 12 months. The legally appointed person can employ licensed dentists and dental assistants and charge for their professional services.
Answer: When employing locum tenens, be prepared to:
Answer: CDA members can log in to access these additional resources when considering locum tenens:
Answer: As is always the case, accurate and timely claim submission is essential for maintaining a seamless workflow. Consider the following points:
In conclusion, properly informing dental benefit plans and submitting accurate claims when adding a new dentist or utilizing locum tenens is essential for minimizing disruption to enrolled patients in California. By following the necessary steps, such as notifying the plans, credentialing and enrolling the new dentist, understanding coding and billing guidelines and collaborating with billing teams, CDA members can navigate these processes effectively and maintain a high level of patient care.
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