11/01/2016

Dentists should respond to dental plan verifications


Dental plans continue to employ a variety of techniques and dedicate resources to verify participating providers’ contact information, ensuring compliance with Senate Bill 137. Dentists contracted with dental plans must respond to a plan’s request for accurate directory information within 30 days or face payment delays, reimbursement reductions or termination of their participating provider agreement.

The intent of SB 137, which went into effect July 1, is to amend the state Health and Safety Code to provide patients with more accurate and complete information as to which dentists are participating in their plan’s provider network. Under the law, health plans are required to maintain accurate provider directories by reaching out to dentists twice per year to verify contact information. CDA continues to explore opportunities to minimize the impact of this legislation for CDA members and streamline the validation process.

In early September, the American Dental Association launched the ADA Credentialing Service as a member benefit to assist dentists by streamlining the submittal of credentialing information to third-party payers, networks, hospitals and employers. While the ADA Credentialing Service does offer the potential to assist member dentists by providing a single point of entry for submitting credentialing information to multiple dental plans, at this time, the ADA Credentialing Service does not meet the requirements of SB 137 compliance in California. CDA members are encouraged to continue responding to requests for verification from contracted dental plans.

CDA offers dentists five key recommendations to comply with SB 137:

  • Know which plans you are participating with as a contracted provider. 
  • Establish a system in the dental practice for tracking dental plan correspondence.
  • Review with care any revised provider agreements or addenda from dental plans.
  • Respond to requests for information promptly, within 30 business days.
  • Report to plan(s) within five business days when there are changes to the information included in the directory. 

CDA Practice Support resources are available to help dentists assess provider agreements. See Dental Benefits Plan Handbook, Chapter 2 and Dental Contracts 101 at cda.org/resources.



Related Items

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.

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.

Topics
Top