Coordination of Benefits

Information and tools for billing on behalf of patients who have dental coverage through more than one plan, including California's coordination of benefits law and when non-duplication of benefits is applicable.

Prepare for CDT 2020 dental code changes
CDA encourages dentists to prepare for CDT 2020 dental code additions, revisions and deletions that go into effect Jan. 1, 2020. The new year will bring 37 new and five revised codes, plus six deleted codes. While dental plans are required to recognize current CDT codes, it is important to keep in mind that they are not required to pay for or provide benefits for the new or revised codes. Dentists should review each dental plan’s payment and processing guidelines to determine whether benefits will be payable.
If I had a magic wand: Reflections on managing dental benefit issues
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.
Get answers from Practice Support experts at CDA Presents
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.
CDT 2017 dental code changes are here
CDT 2017 is the newest version of the American Dental Association’s code on dental procedures and nomenclature. Dentists will need to prepare for the 2017 dental code changes effective Jan. 1, 2017. CDA is happy to see the addition of D4346: Scaling in presence of generalized moderate or severe gingival inflammation.
New balance billing legislation addresses CDA concerns
AB 72 furthers consumer protections while also making it easier for physicians to resolve reimbursement problems with insurers. Under this bill, out-of-network physicians providing treatment at an in-network hospital or clinic must receive a patient’s voluntary consent to be treated for out-of-network care at least one day before the treatment.
Join conversations on dental benefits at CDA Presents
At the 2016 CDA Presents The Art and Science of Dentistry in San Francisco, CDA will engage in conversation with representatives of the dental benefits industry about the likely future direction of dental benefits, the payment policies that challenge dental practices today and the practical approaches in the dental office to successfully administer patients’ dental benefits.
Deadline for Medicare registration extended
The Centers for Medicare and Medicaid Services has extended the deadline for dentists to either enroll as a Medicare Part D "ordering/referring provider" or opt out of the Medicare program entirely. The previous deadline was June 1, but it has now been extended to Feb. 1, 2017.
Adult dental now available through Covered California
Covered California, California’s health insurance marketplace for the federal Affordable Care Act, is now offering family dental plans to purchase for the 2016 benefit year. The standalone family dental plans are available in addition to the children’s dental coverage included as an essential health benefit for consumers younger than 19 years old.
Answers to two common dental benefit questions
CDA Practice Support receives many questions from members about dental benefits. Two of the most common questions are about patient copayments and patient discounts for prepayments. Here are answers to both.
A dentist's rights in a dental benefit plan dispute
CDA receives numerous calls daily about various disputes dentists have with patients’ dental benefit carriers. While CDA will consider how these disputes might be informally resolved, ultimately, the dentist has the right to appeal the dispute back to the plan, and eventually with the plan’s regulator.
Dentists should prepare for 2016 dental code changes
The ADA has released a resource that provides updated information to dentists on all of the latest dental code changes that will go into effect on Jan. 1. CDT 2016 provides accurate and up-to-date ADA dental procedure codes. Dentists who rely on old information may experience unexpected claim denials or reimbursement delays. Code changes for 2016 include 19 new codes, 12 revised codes and eight deleted codes.
Diagnostic code changes approaching
The Centers for Medicare and Medicaid Services (CMS) has set the implementation date of the International Classification of Diseases version 10 Clinical Modification (ICD-10 CM) for Oct. 1. While the implementation of ICD-10 CM affects a limited number of dentists in California, such as oral surgeons, anesthesiologists, pathologists, etc., it is important to note that all dentists should be aware that diagnostic coding could become a requirement in the future.
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