Agmt74 California Dental Servic - Laserfiche WebLink

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(ii) To notify the eligible patient of aLI actions t~ken by CDS with respect to such statementl and (iii) That such statement need not be submitted prior to rendition of service in the case of emergency services or in the case of brief routine procedures. (b) To authorize such statement, for coverage under the dental care program provided by this Agreement when satisfied from the Attending Dentist's Statement and other data submitted by the dentist (l) that the patient is e~bJe hereunderl (2) that the services proposed are included in the Schedute of Services covered by this Agreement set forth tn Appendix "A" attached heretol and (3) that the total fees to be charged to both CDS and the eligible patient do not exceed the dentist's usual, customary and reasonable fees. Such authorization shall be for a meJcimt~n period of sixty (60) days from the date of authorization by CDS, but not longer than the term of this Agreement. (c) To make no payment for services rendered to a patient who is not eligible for dental cere hereunder at the time of rendition of service~ except to the extent of services provided during a period of an authorization issued by COS pursuant to subparagra~oh (b) of this paragra40h, and except for completion of single procedures commenced at a time the patient was entitled to treatme~t by reason of such authorization. CDS may deny payment of a claim for services submitted more than six (6) months after the date the services were provided. If a claim is denied due to the dentist~s f~dture to make timely submiss[on~ the eUgible patient shall not be Uab~e to participating member dentists for the amount e~ CDS~ ce-payment.