Section 1 defines "dental provider contract" as an agreement between a dentist or dental clinic and a dental insurer or third-party administrator ("TPA") under which the dentist or dental clinic provides dental care services.
Section 2 requires that a dental organization proposing a change in an existing dental plan agreement disclose it to the dentist at least 90 days before it goes into effect.
Section 3 requires a dental organization that conducts audits of dental providers to provide a written explanation of the reason for the audit, the processes used to audit patient charts, and the processes available to the provider once the dental organization completes its reveiw of audited patient records. Requires the provider be allowed a reasonable period of time to reveiw and negotiate a resolution to the audit, and requires a licensed dentist to review patient charts.
Section 4 prohibits a dental plan or dental provider agreement from setting fees charged to patients for services not covered by the dental provider agreement. Prohibits third-party administrators from making its providers available to a dental plan that sets fees for noncovered services.
Section 5 makes all sections effective August 1, 2011, and apply to dental plans and provider agreements entered into on or after that date.