Delta Dental recommends that all dentists obtain and use a National Provider Identifier (NPI). All claims submitted are subject to MetLife's The patient should refer to his/her Smiles for Children (SFC) is Virginia's Medicaid and FAMIS dental program for adults and children. We make every effort to ensure that these emails are delivered. On claims, the Type 2 NPI identifies the payee, and may be submitted in conjunction with a Type 1 NPI to identify the dentist who provided the treatment. Dual coveragerefers to when a patient's dental treatment is covered by more than one dental benefits plan. Box 6059 KY Medicaid Dental Fee Schedule 2022 Revised 3/17/2022 Proc Code Procedure Description UNDER AGE 21 Rate 21 and OVER Rate Notes D2161 AMALGAM-FOUR/MORE SURFACES, PRIMARY OR PERMANENT $93.60 $72.00 D2330 RESIN-ONE SURFACE, ANTERIOR $57.20 $44.00 D2331 RESIN-TWO SURFACES, ANTERIOR $71.50 $55.00 D2332 RESIN-THREE SURFACES, ANTERIOR $85.80 $66.00 Dental Preventive Products | A spouse or domestic partners plan is secondary. We strongly recommend that you confirm that a provider is currently participating before you receive any services from that provider. That was pretty easy. Do you submit claims attachments electronically? does not apply for dental service providers that participate with MetLife through To avoid overbilling, always make reasonable efforts to collect patient coinsurance/copayments. Is there a charge to join any of your networks? Here are some suggestions to speed up claim payments. Any additional fee for the nontraditionalmethod is not billable to the patient. PO Box 537007 . Connect with your Delta Dental company to learn more. Narratives must also be maintained as part of the patient treatment record. Dental Finishing Supplies | Example:If you provide treatment for erosion, theres a good chance the claim cannot be paid because erosion is a common exclusion under most dental plans. DELTA DENTAL PATIENT DIRECT GENERAL DENTIST FEE SCHEDULE ALL PROCEDURES Effective from 06/01/2022 D2712 Crown - Resin-Based Composite (Indirect) $305 D2720 Crown - Resin With High Noble Metal $648 D2721 Crown - Resin With Predominantly Base Metal $561 D2722 Crown - Resin With Noble Metal $625 D2740 Crown - Porcelain/Ceramic $725 Preventive services are included in this tool. Dental Set-up & Office Design | "Delta Dental" refers to the national network of 39 independent Delta Dental companies that provide dental insurance. Delaware, District of Columbia, Maryland, New York, Pennsylvania and West Virginia: E-mail:ddpdentist_services@deltadentalpa.org You may be responsible for the cost of procedures or services not covered by your plan. Actual fees charged by your provider may vary for a variety of reasons. Online Dental Supply Company | Dental Supply Store | Dental Companies | Dental Laser - Diode Lasers | Dental Continuing Education Seminars & Resources | Please note that this fee D7410D7415, D7440D7461, D7465, Description of service: Dental Supplies & Specialty Products | Indicate a quantity (the number of x-rays, for example) in the field on the claim specifically for this purpose. We often hear Henry Schein customers state that they arent concerned with balancing UCR fees because they participate with various dental benefit providers. For joint custody, the plan that has covered either stepparent longest provides primary coverage. Lack of sufficient information, especially themembers ID number, is the most common reason for a delayed or denied claim. The amount that would have been payable by Delta Dental may not be charged to the patient. Example: Dental Products - Professional Services | Delta Dental will process the primary benefits, even if processing the secondary coverage must be delayed (for lack of eligibility data, for example). Youll see Delta Dentals payment and the patient portion when the claim or pre-treatment estimate processes, often within moments (when clinical review is not necessary). How much is it going to cost? Massachusetts dentists have a few options: Mail: Provider Enrollment and Credentialing Department (PEC) at Delta Dental of Mass. How will the NPI affect other numbers I've used in the past? All Rights Reserved. For example, if a retiree is employed, the active coverage is primary; the coverage resulting from retirement is secondary. Claims will be processed when received according to your plan provisions. Listerine Ultra Clean Floss | Dental & Porcelain Veneers: Dental Laminates | However, some programs may require you to submit claims within a shorter period of time (e.g., 90 days for Texas CHIP program). Oral surgery (surgical incision/excision), Description of service: For DeltaCare USA, maximum contract allowances are not applicable. By submitting your information, you are agreeing to receive communications from DentalPlans.com. Preventive care coverage varies by plan and by demographic considerations such as age. For more detailed information on your actual dental care costs, please consult your dentist or your Delta Dental. If the patient is a dependent with a disability, enter the nature of the disability. Prior approval is not required when you refer a patient to a specialist. Periodontics (including scaling and root planing), Description of service: Every 12 months you may submit separate Delta Dental Premierfee updates for each practice location, specialty and TIN. Dental Handpieces & Dental Handpiece Repair | Tubing Suction Connect | Appliance name used to control harmful habit. Find the claim number you wish to adjust and choose "Submit a request" in the Claim adjustment section. However, we do suggest that you refer your patients to a Delta Dental Premier participating specialist to minimize your patients' out-of-pocket costs. Use these tips for clear, complete paper claims that will move smoothly through our system. Enter the required documentation information in the Remarks or Comments field of the claim. Oral surgery (biopsy), Procedure codes: The national network of Delta Dental companies protects more smiles than any other insurance company. This website is the home of Delta Dental of California; Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; Delta Dental of West Virginia, Inc. and their affiliated companies. Daniel Ribeiro , has not yet specified details about his education and training. When you submit claims as soon as possible after treatment is completed, you help us process claims more efficiently, using the patients most current eligibility and benefits to determine payment. For a complete description of the details of your coverage, please refer to your coverage documents. Every health care provider transmitting health information in connection with a standard transaction in electronic form must obtain an NPI. Using correction fluid or a highlighter pen. The sample table above is a small selection of common procedures discounted by these discount dental plans and programs. Waiving copayments violates the contracted dentists participation agreement with Delta Dental as well as the patients dental benefits contract. Preventive services are included in this tool. Properly balance your fee schedule to a given percentile to ensure your practice remains competitive in an everchanging dental marketplace. The information and content (collectively, "Content") on this website is for your general educational information only. An NPI is required by the federal Health Insurance Portability and Accountability Act (HIPAA) for electronic transactions. . Alpharetta, GA 30023-1809. Review Sample Pricing with a Savings Plan Below. The cost estimates provided may be different from your actual costs for several reasons, including but not limited to, your unique dental circumstances and the decisions made by you and your dental professionals as to what services you will receive, deviations between the anticipated scope of services and the services actually provided, and the characteristics of your particular plan. Delta Dental Premierand Delta Dental PPO Claims. contain certain exclusions and limitations. Copayment waivers are a form of overbilling the dental carrier. Use of this website in no way increases or decreases the benefits available under a dental benefit plan. The patient is responsible for their coinsurance/copayment portion only. The discounts are available through participating healthcare providers If I submit paper claims and don't use the Internet to check patient eligibility and benefits, do I still need an NPI? Find out more about how this website uses cookies to enhance your browsing experience. Confidential Filed Fee Schedule Actual fees charged by your provider may vary for a variety of reasons. Minneapolis, MN 55440-9304 . Delta Dental of Minnesota provider forms for claims and remittance, dental office support, participation agreements and government programs. The secure version (available only after you sign in) uses procedure costs or cost ranges as reflected in provider fee schedules and aggregated historical cost data. 157 0 obj <>stream Enter your patients name and choose Existing (or enter a new patients information). Copyright 2023 Henry Schein, Inc. All rights reserved. Daniel Ribeiro , Dentist has not yet specified details about his education and training. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. Dental Alloy: Dental Amalgam & Dental Refining | If you or the patient receives more than 100 percent of the fee, the amount in excess should be refunded to the secondary carrier. Example:If a dentist reports a fee for a service as $100, we calculate our payment based on the patients dental benefits contract and, for this example, pay $80 (80% benefit, with 20% patient copayment). This is a10-digit random number unique to each health care provider or organization. Fees with decimal points (for example, 100.00; not 100). processed by MetLife. Type 1 or Type 2 - Which NPI is right for you? Please scroll down and accept to proceed. Free-form text use the Tooth number or letter field to indicate quadrant or arch(e.g., UR or L) and the Remarks box for necessary comments or notes. Dental Evacuation | Simplylog in to Provider Toolsand select "My claims." plan terms. Delta Dental recommends that the NPI be used on all claims. When this occurs, please submit only one claim to the Delta Dental company. Delta Dental has the largest network of dentists nationwide. No data found. When Delta Dental is secondary in dual coverage cases, please include the primary coverages total liability including copayment/coinsurance percentage and the explanation of benefits (EOB). Delta Dental Receiving prompt notification of any invalid data, allowing you to make the necessary corrections and re-submit right away. All of those matters are things that you should decide, in consultation with your dental care professionals. However, there are exceptions, such as theTRICARE Retiree Dental Program (TRDP), a federal plan that follows the effective date rule. Daniel Ribeiro , Dentist has not yet indicated the hospitals that he is affiliated with. If you are looking for a specific dental procedure that is not on this sample, please contact our Customer Care Center toll-free at 1-888-632-5353 with the ADA Code of the procedure and we can provide the discounted fee. Dental Acrylics - Acrylic Resins | The Dental Care Cost Estimator sometimes groups together, into "treatment categories," services that are often delivered together to address a particular dental problem. 465 Medford Street, Ste 400. If you are not submitting claims electronically, talk with your practice management system vendor about activating your systems electronic claims component. You can submit a request for a claimadjustment. Some procedures are not covered under your patient's plan, no matter what documentation is submitted. For extensive or unusual services, what would you need to understand why a patient needs a particular treatment? For more detailed information on your dental care costs, please consult your dentist or your Delta Dental. By entering $80 on the claim, you ensure that Delta Dental calculates its payment based on the fee actually charged, as required under the terms of your agreement with Delta Dental. Primary coverage: natural parent the child lives with, Second: natural parents spouse/domestic partner, Fourth: non-custodial natural parents spouse/domestic partner, Contractual limitations or exclusions that apply to your treatment plan, Determine how best to plan treatment; for example, treatment may be done in segments, over weeks, months or years, to incorporate all available benefits, Develop a payment plan for the patient, taking into account what Delta Dental is expected to pay, Receive email notifications when new documents are available to review online (when you. Dental Scrubs & Uniforms - Fashion Seal Scrubs | Everything you need to know about submitting Delta Dental claims. On a standard ADA Dental Claim Form (#J400), the treating dentists NPI is entered in field 54 and the billing entitys NPI is entered in field 49. If you answer yes to any one of the following questions, you are considered a covered entity under the NPI standard and are required by federal law to obtain an NPI. Maximum contract allowances will differ by 5-digit ZIP code. During clinical review of claims and pre-treatment estimates, Delta Dental reserves the right to request radiographic images and/or documentation for procedures that otherwise may be identied as not requiring the submission of documentation. To get a list of participating specialists in your patients' area, call DASI at 800-524-0149, or use our online . Look at you smiling. Dental Scalers, Power Scaler & Dental Curettes | Charges for clear aligners (e.g., Invisalign, SureSmile) should be submitted using theappropriate orthodontic procedure code (D8010-D8090). (2) Out of Network Range: This range is intended to assist you in understanding P.O. The dental provider listings on DentalPlans.com are provided directly from each dental network or discount dental plan, which are responsible for their accuracy and completeness. The Dental Care Cost Estimator provides an estimate and does not guarantee the exact fees for dental procedures, what services your dental benefits plan will cover or your out-of-pocket costs. However, we strongly encourage you to get one, because you can use it as a single unique identifier with all payers. The secure version (available only after you sign in) uses procedure costs or cost ranges as reflected in provider fee schedules and aggregated historical cost data. Six-digit dates with no spaces, slashes or dashes (for example, 120320 for December 3, 2020). You'll be receiving an email with the information you've requested shortly. Use of this website in no way increases or decreases the benefits available under a dental benefit plan. Preventive care coverage varies by plan and by demographic considerations such as age. Retainer Boxes | Every month, millions of patients use these tools to find, evaluate, and engage with the providers best suited to address their specific needs and preferences. For example, allowances for Delta Dental PPO are different in most cases from those for the Delta Dental Premierplan. Delta Dental PPOSM, PF, 1500A, 100*/90/50, 50 Calendar year costs Deductible $50 per person / $150 family Out-of-pocket maximum (under age 19) $375 for one member / $750 for two or more members (in-network only) Annual maximum (age 19+) $1,500 Class 1 does not apply to max Minimum number of subscribers N/A Class 1 Enter a ZIP Code to see the cities it covers. The description of different treatment categories, and the inclusion of particular services in a treatmentcategory,is not advice that any particular treatment category is the right treatment for you or that you should not obtain any particular treatment. Special promotions including, but not limited to, additional months free are not available We make it easy to protect your smile and keep it healthy, with the largest network of dentists nationwide, quick answers and personalized service. Unscheduled dressing change, Procedure codes: Protect my smile Dental procedures When do you need a root canal? Dental consultants look for reasons to approve your claims. (This might require you to upgrade your software. We update them regularly, usually every 6 to 24 months. The sample table is a small selection of common procedures discounted by these discount dental plans and programs. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. *Not sure where your company is headquartered? When a patient has coverage through TRDP and another dental plan, the plan that has covered the member the longest is considered primary. Delta Dental Patient Direct coverage is not available in all 50 states. Email: CustomerCare.Credentialing@greatdentalplans.com. In such cases, its important to understand that a recommended treatment may be perfectly appropriate. D6055-D6077, D6082-D6088, D6094, D6097-D6099, D6110-D6123, D6194-D6195, Description of service: Such clauses means that the secondary plan will not pay any benefits if the primary plan paid the same or more than what the secondary plan allows for that dentist. 23219For Medicaid EnrollmentWeb: www.coverva.orgTel: 1-833-5CALLVATDD: 1-888-221-1590. Contact the Henry Schein Practice Services team using the contact form and a member of our team will be happy to help you determine the correct fee schedule for your practice. Duplicate radiographs or radiographic image copies of diagnostic quality, including paper copies of digitized images, are acceptable. You no longer need to send us paper claims just because you need to send an attachment. Refer to your benefit plan to determine whether preventive services are covered for you. The cost estimates provided may be different from your actual costs for several reasons, including but not limited to, your unique dental circumstances and the decisions made by you and your dental professionals as to what services you will receive, deviations between the anticipated scope of services and the services actually provided, and the characteristics of your particular plan. We offer vision coverage through DeltaVision in 15 states and the District of Columbia. Chart notes including periodontal case type and diagnosis. the START SEARCH button thats all you need! Delta Dental Mobile App Maximize your oral health and make the most of your dental benefits right from your mobile device by downloading the Delta Dental Mobile App. For further assistance, please contact E-Commerce Technical Support at 1-800-711-6032, Monday through Friday between 8:00am-8:00 pm ET. Help the dental consultant review your claim. Send it to your local Delta Dental by e-mail, fax or U.S. mail: E-mail:dentist_services@delta.org Pre-authorizations or referrals are required for certain benefit plans and certain dental care providers. If the dentist makes no effort to collect the remaining $20 from the patient, then the dentists actual fee for the service is $80, not $100. The procedures discounted under these plans and programs offer similar savings to the sample above. Articulating Paper for Occlusal Contacts & Forces | All of those matters are things that you should decide, in consultation with your dental care professionals. The fee schedules are typically part of the participating provider agreement - a legal contract between the dentist and the third-party payer. an alternative method of treatment is as appropriate and cost-effective. Sacramento, CA 95853-7007 TechCentral - Advanced Technology Solutions and Dental IT Support |
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