Dental Benefits

If you haven’t heard, CDA recently launched a new process for members to report issues and questions related to dental benefits. Although CDA members have had access to a dedicated dental benefits analyst and Practice Support resources since 2009, the online submission form makes it easier for dentists to quickly reach out for assistance and submit their issues 24/7.

As part of the finalized 2019-20 California state budget, the Legislature and Gov. Gavin Newsom approved a continuation of supplemental Medi-Cal provider rates, including significant dollars for dentists serving Medi-Cal patients. An additional $20 million was dedicated to dentists through a recently launched student loan repayment program.

The following are the top 10 “post-op” calls related to dental benefits that CDA Practice Support has received from dentists who made a decision, whether through action or inaction, that resulted in an unexpected outcome and ended with a member saying, “I wish I would have called Practice Support before I …” Included are links to relevant articles offering explanations and helpful resources.

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.

Dentists in 26 counties have a new opportunity to participate in the Dental Transformation Initiative to help improve dental health for low-income children enrolled in the Medi-Cal Program while receiving enhanced reimbursement by meeting specific incentive metrics.

The 2018-19 state budget signed by Gov. Jerry Brown dedicates $210 million from the Proposition 56 Tobacco Tax revenue to Denti-Cal providers, a $70 million increase from last year’s amount. This effort is the result of years of activity to improve the Medi-Cal dental program and increase access to oral health care for the state’s 13.5 million Medi-Cal enrollees.

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.” 

Beginning Jan. 1, 2018, adults enrolled in the Denti-Cal program are eligible for an expanded set of dental benefits. The Department of Health Care Services on Nov. 9 issued a special provider bulletin to clarify the dental services that providers may render, bill and be reimbursed for by Denti-Cal in 2018, including scaling and root planing, partial dentures and posterior root canals.

More than 7 million adults enrolled in Denti-Cal, California’s Medicaid dental program, will have a fully restored package of dental benefits in 2018. The adult benefit package was drastically cut in 2009 due to the state budget crisis and was partially restored in May 2014. The restoration of the adult dental benefit services is a result of legislative action taken during the 2017-18 budget process.

CDA Practice Support occasionally hears a complaint from dental offices that a plan granted a preauthorization for treatment and then denied payment when the claim was submitted. Digging a little deeper into these complaints, there may be some confusion between what constitutes a “preauthorization” and what is a “predetermination” or pre-estimate of benefits.