Appeals

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

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.

An agreement that needs to be read and signed by the dentist when CDA will be handling Protected Health Information obtained from the dentist as we advocated on their behalf with dental benefit plans.  

California law requires every dental plan to have a formal procedure that providers can use to dispute/challenge actions/decisions made by the plan. Overview of plan legal requirements, steps to appealing claims, filing a payment disputes.

This sample letter is for use to respond to a dental plan you are not contracted with claims related to the fee discount of a plan with which you are contracted.

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.

This resource provides information on the state law regarding refund demands from a benefit plan when a patient's coverage has been retroactively terminated.  Includes a sample letter to dispute a refund request from a benefit plan after the plan has paid for services rendered.