Resources and information on dental plan audits; understanding the audit authority of third party payers and requirements; and best practices for patient records.

Clinical Chart Documentation Guidelines

This guide demonstrates patient record best practices. Thorough and accurate patient records are one of your most important tools for telling the story of what happens during treatment.

Delta Dental: On-site Quality Assessment Review Checklist

Use this list to compare aspects of a QA review with your practice's policies and procedures, and be even better prepared for a future on-site QA review.

Dental Benefit Plan Handbook – Chapter 10: Understanding the Claim Appeal Process

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.

Dental Benefit Plan Handbook – Chapter 11: Understanding Dental Benefit Plan Audits

Understanding dental plan authority in quality assurance assessment audits, requirements for the dental practice and best practices for patient records. 

Patient Records - Requirements and Best Practices

Format and content, patient access to records and requests to amend, disclosure of information, data breach notification, retention and disposal, transferring records in a sale.

Pause before you comply with a plan's request for post-payment chart review

Dentists can avoid unnecessary stress by seeking guidance from CDA Practice Support before complying with a dental benefit plan’s request to conduct a post-payment chart review of patient records. 

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.

Retroactive Eligibility Refund Demand and Dispute

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.

Uptick in Quality Assessment audits by Delta Dental of California

CDA has received an influx of member inquiries regarding the recent wave of Delta Dental of California’s Quality Assessment audits. On-site reviews are part of Delta Dental’s Quality Assessment program for contracted dentists in California, mandated by the California Department of Managed Health Care. These reviews evaluate many components of a practice compared to the expectations of dental professionals, regulatory agencies and Delta Dental.