July 26, 2018
As we continue to move to a paperless environment, we would like to remind offices that its mandatory to obtain the patient’s consent to send their personal information to insurance companies. The signed consent form should be maintained as a record in the patient’s file.
An office should obtain consent in the following situations:
- If your office is using CDAnet for claim processing, you must collect the patient’s authorization to send their information to insurance companies. The consent must include the following:
- I authorize release, to my dental benefits plan administrator and the CDA, information contained in claims submitted electronically. I also authorize the communication of information related to the coverage of services described to the named dentist. This authorization shall continue in effect until the undersigned revokes the same.
Signature of patient, parent or guardian: _______________________________ Date: ____________
- It your office accepts assignment of benefits, you must collect the plan members (not the patient) consent. The consent must include the following:
- I hereby assign my benefits, payable from claims submitted electronically, to Dr. __________and authorize payment directly to him/her. This authorization shall continue in effect until the undersigned revokes the same.
You can find the consent authorizations and sample label forms in the CDAnet Dental Office User Guide.