Dental Benefit Plans
Coordination of benefits, fees/discounts/refunds, appeals, billing and contracts
Coverage through dental benefit plans is the primary way patient care is funded. The ability to navigate carriers and plans is key to managing a successful practice. Use these resources to help you navigate provider agreement requirements, manage dental claims, improve your understanding of appeal rights and more.
Adding a Dentist to a Dental Plan as a New Provider
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.
Benefit Breakdown Form
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.
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.
California Department of Managed Health Care Licensed Dental Plans
As a member service, CDA has compiled a list of dental plans from the Department of managed Health Care website.
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.
CDA Business Associate Agreement
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.
Clinical Chart Documentation Guidelines
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.
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.
Considerations When Billing for an Associate
Overview of the payment arrangements to consider once an Associate begins providing treatment in a dental practice.
Current CDT Code Books
Dentistry is an ever-evolving field, and CDT codes are critical to the everyday workings of dental practices.
Delta Dental Litigation Summary
CDA has achieved a favorable settlement on behalf of dentists in our litigation against Delta Dental. CDA took a stand on your behalf — to protect your right to fair dealings — and we succeeded.
Dental Benefit Contracting: It’s Not All About the Fees
Learn how to weigh the costs before you sign a dental benefit participating provider agreement/contract.
Dental Benefits – What You Need to Know
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.
Dental Plan Credentialing
Dental credentialing is the first step in is the process of a dentist entering into a contract with a dental benefit / insurance carrier. Learn more about it in this section of the resource.
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.
Explanation of Benefits
Understand the elements of the Explanation of Benefits and what to look for.
Financial Agreement and Consent Form
Tool to utilize during the patient financial discussion to document financial options presented, patient obligation and financial consent.
Is it a covered benefit? Understanding the noncovered services law
Understand the CA law that regulates what dentists can charge patients for procedures that the policy does not cover AB 2275.
Managing Payment Problems
Learn about your rights and actions you must take when dealing with refund demands made by dental benefit plans.
Medi-Cal Dental Program Handbook
This is a handbook contains summary of key information and requirements of the Medi-Cal Dental Program program.
Offering a Discount Dental Plan in the Practice
This resource will introduce you to the basics of offering an in-house discount plan. These in-house discount plans offer patients some form of dental coverage or benefit to offset their out-of-pocket cost making it more likely that they will accept a treatment plan. Offering an in-house discount plan can assist with attracting new patients and help retain existing patients, particularly those patients without any form of dental coverage.
Patient Records - Requirements and Best Practices
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.
Patient Request to Restrict Disclosure of Patient Health Information to a Dental Benefit or Health Care Plan
Includes information on this patient right to restrict disclosure of patient health information to a dental benefit or health care plan and a sample form to use for a patient who requests such a restriction.
Payment Dispute Resolution Forms and Processes
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.
Sample Practice Sale Notice to Plan Letter
Use this sample letter to notify contracted dental plans of your practice sale and intent to terminate plan participation.
Separating From a Practice Checklist (Associate Dentists)
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.