Dental Benefit Plans

It is required to notify dental plans of a new provider treating patients in the office.  This resource provides information and a sample letter that can be customized and printed on office letterhead when informing dental plans of a new provider.

The quickest and easiest way to verify dental benefits for your patients is through the dental plans’ convenient online portal access where you can view, download, and print a patient’s benefit breakdown. This form may be used when verifying patients' dental benefits via telephone or to supplement the information provided on the dental plan’s online portal.

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.

As a member service, CDA has compiled a list of dental plans from the Department of managed Health Care website.

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.

An agreement that needs to be read and signed by the dentist when CDA will be handling Protected Health Information obtained from the dentist as we advocated on their behalf with dental benefit plans.  

This guide demonstrates patient record best practices. Thorough and accurate patient records are one of your most important tools for telling the story of what happens during treatment.

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.

Overview of the payment arrangements to consider once an Associate begins providing treatment in a dental practice. 

Dentistry is an ever-evolving field, and CDT codes are critical to the everyday workings of dental practices.

Learn how to weigh the costs before you sign a dental benefit participating provider agreement/contract.

This resource may be shared with patients to address some of the common questions about dental coverage and where to go when they are experiencing challenges with their dental plan. 

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.

Understand the elements of the Explanation of Benefits and what to look for.

Does a dental plan continuously deny, delay or underpay your claims or repeatedly fail to comply with legal or contractual requirements? Have you exhausted the plan’s internal provider appeal process? If your answer is yes, your next step is to escalate the issue to the dental plan’s regulator.

Tool to utilize during the patient financial discussion to document financial options presented, patient obligation and financial consent.

Learn about your rights and actions you must take when dealing with refund demands made by dental benefit plans.

This is a handbook contains summary of key information and requirements of the Medi-Cal Dental Program program.

Format and content, patient access to records and requests to amend, disclosure of information, data breach notification, retention and disposal, transferring records in a sale.

There are two levels for appealing payment disputes: first with the plan itself, then with the appropriate regulatory agency. This resource provides a detailed list of contacts and appropriate processes to follow.

Use this sample letter to notify contracted dental plans of your practice sale and intent to terminate plan participation.

A dentist may separate from practice for many reasons, from leaving a group to go into solo practice (or vice versa), determining the office just isn’t the best fit or simply relocating to another region. The checklist that follows is meant as a general guide for associates and does not take the place of legal advice specific and applicable to your situation.

Information regarding the requirements to comply with the No Surprises Act which became effective January 1st, 2022.  The No Surprises Act is an effort to protect individuals and provide transparency related to health care costs. Instructions as well as samples of the required notification and the Good Faith Estimate are included.

When it comes to dental care, patient satisfaction is key, However, despite our best intentions, things may not always go…

This resource lists frequently asked questions around the practice of dental benefit plan network leasing/sharing. The resource will provide you with insight into the practice of PPO network buying and leasing/sharing.

Use this resource in your monthly team meetings and morning huddles to guide your team in effectively responding to patient concerns and objections.