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Dental Benefit Plan Handbook – Chapter 11: Understanding Dental Benefit Plan Audits

October 01, 2020 3896

Dental plans conducting quality assessment audits in dental offices is a common occurrence. It’s often asked, “What will the auditor look for? Can auditors access patient records? What if the assessment finds deficiencies?”

The authority of a dental plan to conduct dental office assessments stems from two sources: the California law that regulates managed health care plans (the Knox-Keene Act) and a dental plan’s contract with its network providers.