A dental plan is auditing my practice - what does this mean ?

Under the California Knox-Keene Act, which regulates managed care, plan provider contracts must ensure that each 'plan shall have access at reasonable times upon demand to the books, records and papers of the provider related to the health care services provided to subscribers and enrollees, to the cost thereof, to payments received by the provider … and … to the financial condition of the provider.'

In sum, the Knox-Keene Act requires plans to assess dental practice financial records and records related to the quality of patient care. It also requires plans to include both a notice of this authority and a written agreement to this access from dentists who become contracted providers within plan networks. Hence, the contract you sign when joining the plan’s network will most likely be a good source of information about dental plan audit requirements.

Every health care service plan, including dental plans, is required to conduct periodic audits of the providers in their networks. These audits enable a dental plan to show state regulators that it is providing quality care to its enrollees and that the overall provider network is financially sound. The audits are not so much a check on the dental office as they are a check on the dental plan itself.

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