California dentists who are willing to relocate, expand or establish a new practice to an area of highest patient need and commit to serving Medi-Cal beneficiaries for at least 10 years can apply in January 2020 to receive up to $300,000 in grant funding through the state’s CalHealthCares program to support related costs.

Today, many dental benefit plans use auto-adjudication to process a high number of their claims. While auto-adjudication can speed up claim processing, if an office is not aware that this type of technology is being used, the office can be confused and frustrated by processing errors as the result of manual claims submission. The following three examples illustrate how a plan might use auto-adjudication and how that process might affect dental reimbursement.

There is an ongoing trend within health care toward integration and consolidation of health care delivery systems. This trend is reflected in provisions of the federal Affordable Care Act, such as the envisioned coordination of care provided under a single entity, the "Accountable Care Organization." The objective of such integration and consolidation is to provide better management of care, create greater efficiencies in the provision of care and improve patient outcomes.

As part of the finalized 2019-20 California state budget, the Legislature and Gov. Gavin Newsom approved a continuation of supplemental Medi-Cal provider rates, including significant dollars for dentists serving Medi-Cal patients. An additional $20 million was dedicated to dentists through a recently launched student loan repayment program.

Delta Dental of California notified California dentists in its FYI newsletter that dentists should be prepared for a quality assessment review. CDA members are encouraged to review the on-site QA review checklist provided in the April 9 newsletter to ensure compliance.

On behalf of members, CDA has filed a legal action against Delta Dental of California in San Francisco Superior Court. The action challenges Delta Dental’s adjustments to Premier and PPO provider agreements effective Jan. 1, 2023.

Whether you are in the process of deciding if you should contract with dental plans or need assistance managing existing dental plans, rely on CDA’s resources and experts for advice and education.

CDA member-dentists can use their voice in two important ways to support dental plan reform and CDA’s advocacy efforts this year: (1) Tell your legislator to support two CDA-sponsored bills that address loopholes in dental plan standards and regulations; and (2) Tell us how your patients’ coverage is disrupting care.
 

CDA has heard from many specialist members — endodontists, periodontists and oral surgeons — who are facing reimbursement reductions under their Premier provider contracts with Delta Dental of California

Update 11/9/22: The CDA-endorsed ballot measure in Massachusetts – Question 2 – passed in Tuesday's election and will require dental insurance companies to spend at least 83% of premium dollars collected on dental services as opposed to using the money for administrative costs and executive compensation.

A proposed rule from the Center for Medicare & Medicaid Services would cover medically necessary dental services as part of the existing medical services benefit in Medicare. CDA last week submitted specific recommendations on coverage of services.
 

It is important that dentists and their teams know and understand their rights when appealing a claim denial and how the law can protect you and your patient. To minimize the frustration of dealing with a claim denial, it is important to understand how a lot of claims are processed today.

A significant amount of activity is underway in the U.S. Congress focused on adding dental, vision and hearing benefits to the Medicare program, and the proposals are moving quickly. This communication from CDA supplements what the ADA, media and other sources have shared to give members background and context for the current activity and clarify some common misunderstandings.

The U.S. Congress is working to finalize the details of President Joe Biden’s Build Back Better Act, and the framework of a final deal is near. While the details of the negotiated agreement have not been made public or acted on by Congress, it appears unlikely that a Medicare dental benefit will be included in the final legislation. 

Delta Dental of California is revising its Delta Dental of California Participating Provider Agreement effective June 1, 2022. Although described as an “enhancement,” the contract amendment alters reimbursement for Premier or PPO contracted dentists who treat DeltaCare® enrollees as out-of-network providers. 

Delta Dental of California has announced a delay in implementing fee structure changes for endodontists, periodontists and oral surgeons. Due to uncertainty caused by COVID-19, Delta said it plans to delay the implementation date of Jan. 1, 2021, to July 1, 2021.

The Department of Managed Health Care asked Delta Dental to report any rate changes affecting over 10% of its provider network to the department. Additionally, DMHC is monitoring its help desk for calls from consumers.  

Reports from CDA members during the last week on contract change notification letters sent by Delta Dental of California raise additional concerns for CDA about the proposed changes.