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Dental Benefit Plans

Coordination of benefits, fees/discounts/refunds, appeals, billing and contracts.

Coverage through dental benefit plans is the primary way patient care is funded. The ability to navigate carriers and plans is key to managing a successful practice. Use these resources to help you navigate provider agreement requirements, manage dental claims, improve your understanding of appeal rights and more.


Adding a Dentist to a Dental Plan as a New Provider

It is required to notify dental plans of a new provider treating patients in the office.  This resource provides information and a sample letter that can be customized and printed on office letterhead when informing dental plans of a new provider.

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.

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.

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.

CDA Business Associate Agreement

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.  

CDA Member FAQ re: Delta Dental 2023 Contractual Changes

Answers to members' questions about Delta Dental’s announced contractual changes announced for Jan 1. 2023.

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.

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.

Delta Dental Litigation Summary

CDA has achieved a favorable settlement on behalf of dentists in our litigation against Delta Dental. CDA took a stand on your behalf — to protect your right to fair dealings — and we succeeded.

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 contracting: It’s not all about the fees

In this article you will learn how to weigh the costs before you sign a dental benefit participating provider agreement/contract.

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 02: Understanding Dental Benefit Plan Contracts & Fees

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

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 04: Understanding Coordination of Benefits

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.

Dental Benefit Plan Handbook – Chapter 05: Working with Patients and Their Plans

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.

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 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. 

Dental Benefits – What You Need to Know

This resource may be shared with patients to address some of the common questions about dental coverage and where to go when they are experiencing challenges with their dental plan. 

Dental Plan Credentialing

Dental credentialing is the first step in is the process of a dentist entering into a contract with a dental benefit / insurance carrier. Learn more about it in this section of the resource.

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.