CDA has received an influx of member inquiries regarding the recent wave of Delta Dental of California’s Quality Assessment audits. On-site reviews are part of Delta Dental’s Quality Assessment program for contracted dentists in California, mandated by the California Department of Managed Health Care. These reviews evaluate many components of a practice compared to the expectations of dental professionals, regulatory agencies and Delta Dental.
State regulators, such as the Department of Managed Health Care and Department of Insurance, require dental benefit plans to have quality management, utilization and antifraud policies and procedures in place to protect plan enrollees. Performing these post-pay chart audits or reviews is one way dental plans comply with this requirement. These reviews verify that dental procedures reported by a dental office on behalf of an enrollee are rendered consistent within the provisions of the dental benefit plan and the participating provider agreement.
Delta Dental of California notified California dentists in its summer 2018 FYI newsletter that dentists should be prepared for a Quality Assessment review. CDA members are encouraged to review the on-site Quality Assessment review checklist provided in the newsletter to ensure compliance. Additional information is available in Section 6 of the Delta Dental Provider Handbook accessible within the provider portal area of Delta Dental’s website (login required).
For additional information on dental plan Quality Assessment audits, see chapter 11, “Understanding Dental Benefit Plan Audits,” of the CDA Dental Benefit Plan Handbook or contact Practice Support for assistance.