Today, many dental benefit plans use auto-adjudication to process a high number of their claims. While auto-adjudication can speed up claim processing, if an office is not aware that this type of technology is being used, the office can be confused and frustrated by processing errors as the result of manual claims submission. The following three examples illustrate how a plan might use auto-adjudication and how that process might affect dental reimbursement.
Improvements to the Medi-Cal Dental program continue with new options for dentists who treat Medi-Cal members, including the ability to provide fluoride treatment and fluoride varnish as a benefit once every four months for patients under age 6. The increase in the benefit periodicity underscores the state’s commitment to regular preventive oral health visits for young children in California.
Adding or dropping a contract with a dental benefit plan is a personal business decision. There is no “one size fits all” in these types of business decisions, as what might work for one dentist might not work for another. You may be asking yourself how a dentist can make a good decision about adding or dropping a dental plan/network participation, but there is one key element in each success story.
Congratulations — the dental plan paid the claim! Or did they? Confirmation that your claim has been processed comes in two forms: payment and/or an explanation of benefits. An EOB is sent to the patient and/or dental office as a receipt of services provided. Unfortunately, dental plans do not have standardized formats for these documents, which is why it’s necessary for an office to read the EOB completely.
What started the legal action that led to this settlement? CDA filed the legal action in August 2013 after learning…
A San Francisco Superior Court judge has granted final approval of the $65 million amended settlement agreement between Delta Dental…
CDA filed the legal action that led to this settlement in August 2013 after learning earlier that year of Delta Dental’s plans to reduce reimbursement rates for the Premier Plan by 8 to 12 percent. CDA claimed that Delta Dental’s attempt to amend the Participating Dentist Agreements (PDA) to pave the way for this reduction was a breach of its “duty of good faith and fair dealing.”
