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Dental Benefit Plan Handbook – Chapter 10: Understanding the Claim Appeal Process

October 01, 2020 1371

By legal mandate, California requires every dental plan to have a formal procedure that network providers can use to challenge adverse payment practices or specific payment decisions.

Described in regulation as the “fast, fair and cost-effective dispute resolution mechanism,” the provider dispute resolution process adopted by each plan is supposed to be just that -- fast, fair and cost-effective.