Billing

Resources and information on laws related to dental benefits; eligibility verification; proper coding; understanding how to properly bill for treating providers; and navigating the payment dispute process.

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.

Considerations When Billing for an Associate

Overview of the payment arrangements to consider once an Associate begins providing treatment in a dental practice. 

Current CDT code books

Dentistry is an ever-evolving field, and CDT codes are critical to the everyday workings of dental practices.

Dental Benefit Plan Handbook – Chapter 01: Understanding Dental Benefit Plan Coverage

Overview of the types of dental coverage and the differences between dental and medical coverage, in order to aid dentists in explaining dental coverage to patients.

Dental Benefit Plan Handbook – Chapter 03: Verification and Explanation of Dental Benefit Coverage

Tips for verifying coverage with a patient's plan and providing explanation to help patients interpret benefits, limitations, exclusions, financial responsibility and how to maximize coverage.

Dental Benefit Plan Handbook – Chapter 06: 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.

Dental Benefit Plan Handbook – Chapter 07: Billing Medical Plans

Learn cross-coding: billing medical insurance in a dental office; how to select the correct CPT code and ICD-10 codes when billing medical plans.

Dental Benefit Plan Handbook – Chapter 08: Explanation of Benefits

Understand the elements of the Explanation of Benefits and what to look for.

Dental Benefit Plan Handbook – Chapter 09: Managing Payment Problems

Learn about your rights and actions you must take when dealing with refund demands made by dental benefit plans.

Dental Plan Questions are Attempt to Ascertain Primary Payer

Clarifying dual insurance and coordination of benefits "rules" when it pertains to the children of divorced parents. What questions to ask and the "rules" surrounding who is primary and secondary.

Financial Agreement and Consent Form

Tool to utilize during the patient financial discussion to document financial options presented, patient obligation and financial consent.

Is it a covered benefit? Understanding the noncovered services law

Understand the CA law that regulates what dentists can charge patients for procedures that the policy does not cover AB 2275.

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.

Prevent Billing Problems and Stress During Leaves of Absence

Understand how a dentist's absence in the practice could result in dental claim processing issues and how to develop a plan of action to reduce complications.

Professional Courtesy for Dental Treatment: An Employee Benefit

Outlines sample policy language and considerations for billing when employees have dental benefit plan coverage. 

Sample Letter to Third Party Payer for Temporary Dentists

This sample letter should be customized and printed on office letterhead to notify a Third Party Payer when a temporary dentist will be filing in for a dentist on a leave of absence.  Commonly used in Locum Tenens, Disability Leave, Maternity Leave and other situations in which a licensed dentist who is not currently practicing at the office will temporarily be performing treatment on patients on behalf of a licensed dentist that is currently practicing at the office.

Steps to Comply with the No Surprises Act

Information regarding the requirements to comply with the No Surprises Act which became effective January 1st, 2022.  The No Surprises Act is an effort to protect individuals and provide transparency related to health care costs. Instructions as well as samples of the required notification and the Good Faith Estimate are included.

 

Teledentistry Consent and Notice

This form serves both as a notice that complies with the Dental Board’s requirement and to obtain informed consent for teledentistry.

Teledentistry FAQs

Telehealth/teledentistry coding options, consent, and resources.