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.
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
Q&As, coding information and a sample notice and consent form required by the Dental Board.
The Associate Dentist’s Role in Audits, Complaints and Dental Board or Dental Plan Grievances
When it comes to dental care, patient satisfaction is key, However, despite our best intentions, things may not always go…
Understand Dental Benefit Plan Network Leasing/Sharing
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.
Understanding Common Patient Objections
Use this resource in your monthly team meetings and morning huddles to guide your team in effectively responding to patient concerns and objections.
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.
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.
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.
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.
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.
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.
What You Need to Know About Dropping Dental Plan Contracts
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.
Why Do Dental Plans Conduct Credentialing
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.
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.