Dental Benefits Resources from WSDA
WSDA is committed to supporting member dentists and their offices on dental benefits issues. Whether you have problems with a specific claim, broader issues with an insurance company, or general dental benefits questions, we're here to help.
Dental Benefits Concierge Service
Personal Dental Benefits Support
WSDA's Dental Benefits Advocacy Manager Crystal McGaffin is here to provide 1:1 support for WSDA member dentists and any staff in your office.
Crystal can support you with questions on:
- Coding and Reimbursement
- Credentialing & Third-Party Payor Issues
- Dental Benefits Advocacy
- Other Dental Benefits Issues in Your Office
Contact Crystal today at dentalbenefits@wsda.org.
NEW Resource: Delayed Claim Payment Letter Templates
Download these letter templates to use in your office to communicate with insurance companies and/or their contractors regarding delayed claim payments or to address disputes about claim adjudication and resolution that exceed the insurer or regulatory standards.
Please note:
- These templates are not applicable to Medicare/Medicaid or other federally regulated dental benefit programs. Always follow the specific terms of participation for any government program.
- These templates are not applicable to plans regulated under ERISA, such as self-insured plans.
- These templates assume a “clean claim” — a claim submitted correctly with no errors, missing information, or lacking documentation that would prevent timely processing.
- When in doubt, defer to the terms stated in your provider contract. We also encourage you to use provider relations or escalation channels and invoke the contract's dispute resolution process.
Questions about the above? Please email dentalbenefits@wsda.org.
Templates
Please replace all bracketed and highlighted sections of the letter template with information specific to your office and the claim, making sure to remove the template filler text and highlights.
Letter 1 - Provider Reimbursement, 1st Attempt
Download:
Who to send to:
- Dental Benefits Carrier
When to send:
- Once the carrier has confirmed receipt of a claim, send promptly after 30 days have passed without receiving payment. If your provider contract specifies a different timeline, defer to the contract.
- Please note that the clock starts when the claim is received by the payor and they have confirmed receipt.
Letter 2 - Provider Reimbursement, 2nd Attempt
Download:
Who to send to:
- Dental Benefits Carrier
When to send:
- Send promptly 15 days after first letter, if no response/resolution.
Letter 3 - Provider Reimbursement, Final Attempt
Download:
Who to send to:
- Dental Benefits Carrier
When to send:
- Send promptly 15 days after second letter (exceeding 60 days after date of service), if no response/resolution.
Letter 4 - Attempt to Resolve: Third Party Administrator
Download:
Who to send to:
- Third Party Administrator/Contractor
When to send:
- Send immediately following a letter to the insurer
Have questions about using these letters, delayed claim payments, or still facing issues with an insurer paying a claim after sending? Contact WSDA at dentalbenefits@wsda.org.
Recent Changes to WA Dental Benefits Law
Same-Day Denials & Virtual Credit Cards
A result of WSDA’s successful 2025 dental benefits reform campaign and passage of Senate Bill 5351, changes affecting insurance practices related to same-day denials and virtual credit card payments went into effect July 27, 2025.
- Same-Day Denials: A carrier can no longer deny coverage for procedures solely on the basis that the procedures were performed on the same day.
- Virtual Credit Cards: A carrier can no longer require you to accept payment through a virtual credit card that carries fees.
WSDA members can log in for more details on these new requirements.
If you believe a dental benefits carrier is in violation of these new requirements, please email WSDA at dentalbenefits@wsda.org.
