Quick overview of CDA’s Dental Benefit Plan Handbook

CDA Practice Support recently revised the Dental Benefit Plan Handbook.

Much the way that a full breakdown of benefits gives the office and patient a comprehensive look into policy benefits, limitations and exclusions, the Dental Benefit Plan Handbook provides a full breakdown of the dental benefits marketplace for practice owners and their staff. The handbook’s 11 chapters cover industry standards, unique policy differences, laws and ethics.

Here’s a summary of what’s covered in each chapter:

Chapter 1, “Understanding Dental Benefit Plan Coverage,” helps an office maximize its patients’ dental plan benefits. Both dental practice staff and the patient should understand the type of services covered by the patient’s plan including, specifically, the plan’s limitations and exclusions. This chapter educates staff on the many types of dental coverage and the differences between dental and medical coverage in order to aid you in explaining dental coverage to patients.

Chapter 2, “Understanding Dental Benefit Plan Contracts and Fees,” defines the types of plans to consider for the practice and explains contract analysis, how to establish fees and much more.

Chapter 3, “Verification and Explanation of Dental Benefit Coverage,” explains the process of verifying dental benefit coverage with a patient’s plan. Providing patients with an explanation of coverage is a critical first step in building a trusting relationship with them.

Chapter 4, “Understanding Coordination of Benefits,” explains the California law pertaining to coordination of benefits.

Chapter 5, “Working with Patients and Their Plans.” In this chapter, we tell you how to help patients understand the relationship between the practice and a dental benefit plan. Whether or not the provider participates with the patient’s plan, every provider faces the question: “Do you accept my insurance?” Every practice should be prepared to not only answer this question but guide the patient through the steps of verifying eligibility and explaining how the practice works with dental benefit plans.

Chapter 6, “Completing and Filing the Claim Form,” describes how to correctly complete the claim form.

Chapter 7, “Billing Medical Plans.” In this chapter, we help you determine the correct CPT code and ICD-10 codes when billing medical plans.

Chapter 8, “Explanation of Benefits,” shows you how to read the statement sent from the dental plan following the processing of a dental claim.

Chapter 9, “Managing Payment Problems,” looks at claim denials and ways to reduce or avoid denials.

Chapter 10, “Understanding the Claim Appeal Process,” covers the California legal mandate requiring every dental plan to have a formal procedure that providers can use to challenge adverse payment practices or specific payment decisions. This chapter walks you through the proper steps in appealing a claim.

Chapter 11, “Understanding Dental Benefit Plan Audits.” In this chapter, we explain the audit authority of dental plans to conduct quality assessment audits of their contracted dental offices. We answer common questions like, “What will the auditor look for?”, “Can auditors access patient records?” and “What if the assessment finds deficiencies?”

Access all chapters in the Dental Benefit Plan Handbook.

Related Items

CDA Practice Support continues to receive calls from member dentists regarding Delta Dental of California’s recently implemented contractual change under Participating Dentist Rule 2, Basis of Fees. In a letter mailed to participating providers in January, Delta Dental of California shared revisions to its provider participation documents. Specifically, Appendix A – California Participating Dentist Rule 2 — was revised.

Every year, CDA encourages all dentists to prepare for dental code additions, revisions and deletions. The ADA has released the CDT 2019 with 15 additions, five revisions and four deletions that will go into effect Jan. 1. It is recommended that all dental offices have a current copy of the CDT to assist with proper claim billing. Typically, plans will start sending updates about policy changes for the new year during the fourth quarter.