Payment Dispute Resolution Forms and Processes

There are two levels for appealing payment disputes: first with the plan itself, then with the appropriate regulatory agency. This resource provides a detailed list of contacts and appropriate processes to follow.

Putting On and Taking Off PPE

CDC Guidance for Donning and Doffing Personal Protective Equipment (PPE) 

Hiring Temporary Employees Toolkit

Short-term employees are considered employees by the State of California and require additional documentation. This toolkit covers hiring, paying and terminating temporary employees.

Conducting a Self-Audit

Info on practice management audits: practice strategic plan, production goals and revisions to schedule, chart audit, financial audit, billing, and how to update management policies and procedures.

Legal Reference Guide for California Dentists: Appendix C - Formation of a Group Practice Checklist

Checklist of the items that should be addressed or considered when forming a group dental practice.

Step 4: Reporting Requirements

Dental offices administering waived COVID-19 tests are required to report test results within a defined period through the state reporting system. 

Regulations on Dentists Initiating and Administering Vaccines

A dentist who prescribes and administers any vaccine must follow requirements for training, continuing education, notifications, reporting and documentation established in Section 1066 of Title 16 of the California Code of Regulations.

California Department of Managed Health Care Licensed Dental Plans

As a member service, CDA has compiled a list of dental plans from the Department of managed Health Care website.

COVID-19 Vaccine Training Requirements

Dentists are now required to complete one CDC-hosted training course instead of the previously required four courses. Find out where to access these free, online training modules. 

Vaccine Facts and Communications

Encourage vaccination with resources for flu and covid-19 vaccines and pregnancy.

Step 5: Billing & Reimbursement

CDA provides the following billing information and FAQs to help dentists better understand their rights under AB 526.

California Department of Managed Healthcare - Information on Provider Complaints

After filing a provider dispute/complaint/appeal with a dental plan, learn how to file a 2nd level provider complaint with the California Department of Managed Healthcare.

Air Tank and Compressor Inspection and Permit

An overview of the Cal/OSHA requirements for a dental practice to have an air compressor/tank permit.

Meal and Rest Break Printable Sign

If you want to reduce your risk of labor litigation, it’s important you understand California’s meal and rest break requirements.

Benefit Breakdown Form

The quickest and easiest way to verify dental benefits for your patients is through the dental plans’ convenient online portal access where you can view, download, and print a patient’s benefit breakdown. This form may be used when verifying patients' dental benefits via telephone or to supplement the information provided on the dental plan’s online portal.

Health History Form: Confidential (English & Spanish)

This form should be completed by each new patient or a new patient’s legal guardian. Additionally, this form should be reviewed at each patient appointment with changes noted and signed for. Used with permissions from TDIC.

Declination of Employer Recommended or Required Influenza (flu) Vaccination

Form to document employee refusal of recommended or required flu vaccination.

Patient Request to Restrict Disclosure of Patient Health Information to a Dental Benefit or Health Care Plan

Includes information on this patient right to restrict disclosure of patient health information to a dental benefit or health care plan and a sample form to use for a patient who requests such a restriction.

Caregiver’s Authorization Affidavit

A minor patient who does not have a parent in their life may be under the care of a family member who is not a legal guardian. Use the affidavit when the family member seeks dental treatment for the minor.

 

Patient Notifications and Disclosures Checklist

This is a checklist of required patient and public notifications and disclosures.

Final Pay Explained

California law requires employees receive their final paychecks within a certain time based on the reason they separated. 

30-60-90 Day Performance Evaluation

Studies show employee retention increases when employers invest in the initial first months of employment. Doing reviews at the first 30, 60, and 90 days of an employee's tenure with a practice is a great way to provide them with feedback on their performance, and it offers them the opportunity to tell you what is going well and where they need help. Use this form to conduct and document 30-60-90-day reviews with your new employee.  

Completing and Filing the Claim Form

Common reasons for claim delays and denials; correct use of procedure codes, Tax Identification (TIN) and National Provider Identification (NPI); practice’s fee schedule and radiographic image attachments; electronic claim (E-Claim) filing.

CFRA Designation Notice

Designation of a CFRA leave is a two-step process: employee notice of the need for a CFRA leave and employer designation of the leave as CFRA leave.

Sample California Family Rights Act (CFRA) Policy

Employers of five (5) or more employees must provide information about their CFRA policy and post this information in a conspicuous place where employees tend to gather.

Small Employer Guide to California Family Rights Act (CFRA)

A comprehensive resource to help employers navigate the complexities of CFRA compliance as of January 1, 2021, including determining employee eligibility, meeting time-sensitive obligations and managing leave.

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