05/14/2019

California-contracted dentists should prepare for a quality assessment review, says Delta Dental


Delta Dental of California notified California dentists in its FYI newsletter that dentists should be prepared for a quality assessment review. CDA members are encouraged to review the on-site QA review checklist provided in the April 9 newsletter to ensure compliance.

On-site reviews are part of Delta Dental’s quality assessment program for contracted dentists in California, mandated by the California Department of Managed Health Care. These reviews evaluate many components of a practice compared to the expectations of dental professionals, regulatory agencies and Delta Dental.

State regulators, such as the Department of Managed Health Care and Department of Insurance, require dental benefit plans to have quality management, utilization and antifraud policies and procedures in place to protect plan enrollees. Performing these post-pay chart audits or reviews is one way dental plans comply with this requirement. The reviews verify that dental procedures reported by a dental office on behalf of an enrollee are rendered consistent within the provisions of the dental benefit plan and the participating provider agreement.

Additional information is available in Section 6 of the Delta Dental Provider Handbook accessible within the provider portal area of Delta Dental’s website: www.deltadentalins.com/dentists (login required).

Review the on-site QA review checklist in Delta Dental’s FYI newsletter. Find more information on dental plan quality assessment audits in chapter 11 of the CDA Dental Benefit Plan Handbook (CDA login required) or contact Practice Support for assistance at 800.232.7645.



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Many dental benefit plans have adopted contracting based on the contract of the treating dentist, not just the billing (owner) dentist. When billing a benefit plan, the information documented on the claim in the billing dentist or billing entity, treating dentist and treatment location sections must all be accurate. If the treating dentist documented on the claim differs from the treating dentist noted in the patient’s chart, it’s considered to be fraudulent billing.

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