Dental Benefit Plan Basics

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.

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.

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

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

Understanding plan policies for coordinating payment of benefits when enrollees or policyholders have more than one dental benefit policy. Explanation of CA law pertaining to coordination of benefits.

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

Defines the types of plans to consider for your practice, contracting & contract analysis, billing & how to establish fees and more.

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.

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.

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.

Help patients understand the relationship the practice holds with plans; overview of: in network, out of network, pre-authorization, predetermination, discounts, dual coverage and claims.