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2021 Q4 Practice Health Check: Dental Benefit Plans

October 01, 2021 3450

Are you prepared for the 2022 current dental terminology (CDT) code changes?

The American Dental Association (ADA) updates the current dental codes (CDT) annually. To avoid claims delays or denials in the upcoming year, it is important to understand how the codes have changed year to year. Visit ada.org to obtain a copy of the ADA CDT 2022 code book.\

Resource: Chapter 6 of the CDA Dental Benefit Plan Handbook “The Use of Procedure Codes on the Claim Form”

Keep an eye out for dental benefit plan end-of-year communications. Many plans send notices to dental offices at the end of the year outlining upcoming changes to their processing policies in light of the upcoming CDT codes. 

Below is an example of a notice sent by Delta Dental of California to their Participating Providers in September of 2021 outlining their processing policies for 2022:     

“Claims submitted with new CDT 2022 procedure codes will be processed according to Section 2 of the Delta Dental of California Participating Dentist Rules (available in the Dentist Handbook under Appendix A). This means that until you establish a Premier Contracted Fee for a new code, payment will be based on the applicable Delta Dental PPO fee schedule or your submitted fee, whichever is less. You may file a fee for these new codes any time after January 1, 2022 without affecting your current fee filing anniversary date. Filing for any other codes will result in a reset to your fee filing anniversary date and/or rejection of your fee filing submission, so it’s important to only submit for the new CDT 2022 codes. After January 1, 2022, if it has been at least 12 months from the last time you have filed your fees, you may file for any procedure code, including the new CDT 2022 procedure codes.”

Learn more: Understanding Dental Benefit Plan Contracts & Fees, see section titled “How often should fee schedules be updated?” 

Reach out to your patients to encourage them to use their dental benefits before the end of the year.

Most dental benefit plan maximum annual coverage dollars are lost if not spent before the end of the benefit year. As 2021 comes to an end, it is important to educate your patients on how they may take full advantage of their dental coverage and complete treatment plans.

Learn more: Dental Benefit Plan Handbook – Chapter 03: Verification and Explanation of Dental Benefit Coverage

 

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