Dental Benefit Plans

CDA recently became aware of a court ruling in the Moneim, DDS, et al., vs. Delta Dental of California litigation. It is our understanding that the court has ruled on some of the legal issues involved in this case, but this ruling is only part of the case as the court divided the case into 2 phases.

This resource will introduce you to the basics of offering an in-house discount plan. These in-house discount plans offer patients some form of dental coverage or benefit to offset their out-of-pocket cost making it more likely that they will accept a treatment plan. Offering an in-house discount plan can assist with attracting new patients and help retain existing patients, particularly those patients without any form of dental coverage.

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.

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.

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. 

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.

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.

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

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.

Use this sample letter and instruction to inform dental plans of a business Tax Identification Number change.

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.

Use this sample letter to notify contracted dental plans of your practice sale and intent to terminate plan participation.

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.

Q&As, coding information and a sample notice and consent form required by the Dental Board.

When it comes to dental care, patient satisfaction is key, However, despite our best intentions, things may not always go…

This resource lists frequently asked questions around the practice of dental benefit plan network leasing/sharing. The resource will provide you with insight into the practice of PPO network buying and leasing/sharing.

Use this resource in your monthly team meetings and morning huddles to guide your team in effectively responding to patient concerns and objections.

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.

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.

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.

A guided checklist to assist dentists with things to consider before, during and after withdrawal from a plans network, including sample letters for use in your practice.

Dental plans conduct credentialing, which is the collection and verification of an applicant’s professional qualifications such as relevant training, licensure, certification, and/or registration to practice in a health care field and academic background, as well as an assessment of whether the practitioner meets certain criteria relating to professional competence and conduct.