08/16/2016

Provider directory compliance letters in the mail


Delta Dental has initiated the first of a three-phase mailing to participating dentists as part of the provider directory verification process required by California Senate Bill 137. Hard copy letters were mailed to more than 8,600 dental practices located in various parts of the state, ranging from Alameda to Riverside counties, the first week of August.

Dental practices in the counties listed in the chart below will receive the first-round correspondence from Delta Dental regarding SB 137 compliance.

The intent of SB 137 is to provide patients with more accurate and complete information as to which dentists are participating in their plan's provider network.

While dental plans have varied their approach in how they contact dentists and obtain verified provider directory information, Delta is sending letters to its participating providers in three phases to both minimize the impact on providers and ensure the plan's timely processing of the responses. Phase II letters will be sent to more than 9,000 practice locations, including Los Angeles, Sacramento, San Benito and San Bernardino counties, in the coming weeks. The phase III letters will be sent to more than 8,700 practice locations, including those in San Diego and Yuba counties, on a to-be-determined future date.

Dentists who received a letter from Delta Dental in phase I are required to comply with SB 137 by verifying or updating their dental practice information by Saturday, Sept. 10. This can occur one of two ways, either electronically via Delta Dental's provider tools or by completing the form enclosed with the letter.

Dentists participating as contracted providers with Delta Dental or other dental plans are required to respond to a plan's request for verification of directory information within 30 days of receipt of request. Failure to respond within the required time frame will result in delays or reductions of payments.

Under SB 137, dentists have five days to notify contracted plans if there are any changes to the directory information, including a change of address and telephone number, as well as if the dental practice is no longer accepting new patients from that plan or is now open to accepting new patients.

The following recommendations can assist dentists with SB 137 compliance:

  • Know which plans you are participating with as a contracted provider. According to recent data from the National Association of Dental Plans, most dentists participate with an average of six dental preferred provider organizations, two dental health maintenance organizations and two discount plans. Dentists should identify which DPPO, DHMO and discount plans they are currently contracted with and vigilantly review incoming correspondence from those plans.
  • Establish a system in the dental practice for tracking dental plan correspondence. Carefully review all correspondence to determine if further action is required. Additionally, consider establishing a separate email address for incoming and outgoing correspondence and/or designate a staff person to review all incoming hard copy and electronic dental plan correspondence.
  • Review with care any revised provider agreements or addenda from dental plans. Dental plans will need to document the revised dentist requirements for SB 137 compliance. This may include a contract addendum, an entirely revised provider agreement or an opt-in/out letter. Review these documents carefully to evaluate the impact on the dental practice. CDA Practice Support offers several contract resources online to assist with assessing provider agreements. Visit cda.org/practicesupport for more information.
  • Respond to requests for information promptly, within 30 business days. Document all correspondence sent to the plans and retain copies of contracts, forms, etc. Retain a copy of any documents sent to the plans in the event that the dental plan fails to receive it.
  • Report to plan(s) within five business days when there are changes to the information included in the directory. Dentists must report to the plan if there are changes to the directory information for the practice (address, telephone number, email address, ability to accept new patients, etc.).
Phase I

Phase II

Phase III

Alameda

Los Angeles

San Francisco

Alpine

Sacramento

San Joaquin

Amador

San Benito

San Luis Obispo

Butte

San Bernardino

San Mateo

Calaveras

 

Santa Barbara

Colusa

 

Santa Clara

Contra Costa

 

Santa Cruz

Del Norte

 

Shasta

El Dorado

 

Sierra

Fresno

 

Siskiyou

Glenn

 

Solano

Humboldt

 

Sonoma

Imperial

 

Stanislaus

Inyo

 

Sutter

Kern

 

Tehama

Kings

 

Trinity

Lake

 

Tulare

Lassen

 

Tuolumne

Madera

 

Ventura

Marin

 

Yolo

Mariposa

 

Yuba

Mendocino

 

 

Merced

 

 

Modoc

 

 

Mono

 

 

Monterey

 

 

Napa

 

 

Nevada

 

 

Orange

 

 

Placer

 

 

Plumas

 

 

Riverside

 

 

 

For more information regarding SB 137 compliance, contact CDA Public Policy at 916.554.4984.

Updated: 08/18/16



Related Items

SB 137 requires dental plans to comply with uniform standards and provide timely updates for their provider directories and there are two numbers you need to know to ensure compliance with the new law that goes into effect July 1 — 30 and five. The goal of this legislation and resulting regulations is to provide patients with more accurate information to identify which dentists are participating with their dental plan.

A law created by Senate Bill 137 goes into effect on July 1 and requires all health plans to maintain accurate provider directories. This law requires dentists contracted with dental plans to respond to a plan's request for accurate directory information within 30 days or face payment delays, reimbursement reductions or, ultimately, termination of their participating provider agreement.

A law created by Senate Bill 137 goes into effect on July 1 and requires all health plans to maintain accurate provider directories. This law requires dentists contracted with dental plans to respond to a plan’s request for accurate directory information within 30 days or face payment delays, reimbursement reductions or, ultimately, termination of their participating provider agreement.

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