Appeals

Learn to resolve payment disputes with self-funded, commercial and government sponsored plans, including sample letters and regulations.

Provider dispute process offers fair, fast and cost-effective resolution
08/23/2018
Simply asking a plan to reconsider a decision does not initiate the provider dispute mechanism. A request made by phone call or email or otherwise not made according to the plan’s established procedure will be treated as an informal appeal, which should be used only once. If it does not result in resolution, the dentist should file an appeal through the provider dispute resolution process established by the dental plan.
If I had a magic wand: Reflections on managing dental benefit issues
11/20/2017
Greg Alterton is approaching his 16-year anniversary with CDA. He worked in the CDA Public Policy Division for 13 of those 16 years, where he was involved in developing dental benefits legislation sponsored by CDA. He has assisted individual members directly with their dental benefit issues while in Public Policy and during the past three years with CDA Practice Support. He retires from CDA at the end of 2017.
Calling benefit plans for resolution or spinning your wheels?
08/02/2017
There’s a reasonable assumption that calling a dental plan about a payment dispute will resolve the dispute. We’d all like to think this works more often than it actually does, but the reality is that informal calls to dental plans about payment or other issues the dental practice is having with a dental plan may not quickly lead to resolution.
Get answers from Practice Support experts at CDA Presents
04/14/2017
Addressing patients’ clinical needs is what every dentist is taught in dental school. What a dentist is not taught is how to run a small business with employees and how to navigate patients’ benefit plans. CDA Practice Support experts will be on-site at CDA Presents Anaheim, at the Member Benefits Center, to answer members’ questions about dental benefits, employment and regulatory issues. Additionally, each expert will present a free one-hour lecture at The Spot Educational Theater. Topics include the dental benefits grievance process, HIPAA compliance essentials and lesser known employment laws.
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