You'll be receiving an email with the information you've requested shortly. Fax: 617-886-1414. Medicaid members can now access more dental services. Costs Locate Providers Insurance Appeals and Assistance Quality of Care, Literacy and Reform Wellness Dental/ Oral Health Disability and Condition-Specific Palliative Care Surprise Billing By State. If you . Latex Exam Gloves | The NPI replaces other identifying numbers used in electronic transactions, such as: The NPI willnotreplace these numbers, which are used for purposes other than general identification: NPIs are issued by the National Plan & Provider Enumeration System (NPPES). 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. Generally, Delta Dental allows one reevaluation per claim. The information provided here is for educational purposes only and should not be interpreted as legal advice. hbbd```b``z"g E,r D2`i`v X.X1X$ LNH`Xed_@d:H=D bg`ig ^ Dental Tools & Instruments - Hand & Surgical Instruments | Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas, Utah and U.S. Virgin Islands: E-mail:ProfessionalServices@ddic.delta.org These listings are updated on a regular basis, and every effort has been made to ensure that only participating active providers are listed. 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). However, if the primary carrier only pays 50% of the dentists allowed fee, then the secondary carrier would reduce its payment by the amount paid by the primary plan and pay the difference. Every health care provider transmitting health information in connection with a standard transaction in electronic form must obtain an NPI. For example, if a retiree is employed, the active coverage is primary; the coverage resulting from retirement is secondary. Lack of sufficient information, especially themembers ID number, is the most common reason for a delayed or denied claim. Indication if this is an initial claim or a transfer case. Periapical radiographs - pre- and post-operative. All CDT codes not listed are discounted 20% off the usual fee. Always notify Delta Dental of the actual fee charged. Verify that the dentist is your selected DeltaCare USA primary care dentist before each appointment. Our procedure fee tool provides participants of dental plans insured or administered Boston, MA 02129. out additional fee information on common procedures in your area, the process is Everything you need to know about submitting Delta Dental claims. Get started here. How will the NPI affect other numbers I've used in the past? This website shows estimates of certain dental care costs. (1) Network Fee: This fee represents what most dental service providers For other Delta Dental member companies, please check how they prefer to register your NPI. Have a question about coverage or looking for dental insurance? Please contact the Delta Dental company below for more information. In such cases, its important to understand that a recommended treatment may be perfectly appropriate. the latest UCR update for all ADA codes July 1. The SFC program is managed by Dentaquest. Discounted fees listed under "Routine Dental Fees", "Fillings & Crowns" and Root Canals, Perio & Dentures tabs are for participating General Dentists. In this case, generally, the plan through current employment is primary. The information and content (collectively, "Content") on this website is for your general educational information only. To be sure, please refer to your dentist handbook. 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 identified as not requiring the submission of documentation. Next, in the Type of Transaction menu, choose Pre-Treatment Estimate. Anticipate what questions a dental consultant may have regarding a particular claim and provide the reason it should be paid. Find health-related articles, product discounts and wellness benefits, Connect remotely with your patients using At Henry Schein, you can Rely on Us for all of your dental practice needs. The data is based on actual, non-discounted charges that providers have billed. View plans, sample savings & pricing, patient reviews & practice information. Members have a fixed copayment for all covered services and cannot be balance billed. Dental Alloy: Dental Amalgam & Dental Refining | Your knowledge and expertise about dentistry will likely come across clearly if you remember that your audience is a dentist just like you. Receiving prompt notification of any invalid data, allowing you to make the necessary corrections and re-submit right away. Dental Set-up & Office Design | Properly balance your fee schedule to a given percentile to ensure your practice remains competitive in an everchanging dental marketplace. Fax: 717-774-1770 For more detailed information on your actual dental care costs, please consult your dentist or your Delta Dental. Connect with your Delta Dental company to learn more. You may be responsible for the cost of procedures or services not covered by your plan. Once youve registered your NPI with Delta Dental, you should begin using it on claims. ), you are responsible for submitting an update to the NPPES within 30 days of the change. hb```g``Zpj1 X{ y `` Estimated fees for Zip Code The procedure fee displayed can differ if your dental service providers office is located outside the zip code indicated. Dental Acrylics - Acrylic Resins | Checking the patients Evidence of Coverage for both plans will help you determine when a medical plan is primary. Enter city and state to see all the ZIP Codes for that city. Dental Office Dcor Reception Room Furniture | Dental Scrubs & Uniforms - Fashion Seal Scrubs | If the member has two plans through current employment at two jobs, then the plan that has been in effect the longest is usually primary. Please do not submit original radiographic images if they are the only diagnostic record for your patient. Dental Equipment Sales & Services | To obtain your NPI, simply go to theNational Plan and Provider Enumeration System (NPPES) and follow the instructions to complete the application. %%EOF contain certain exclusions and limitations. Notes: U. S. Mail:Delta Dental of Pennsylvania,ATTN: Provider Onboarding, P.O. You can ask the patient to advise us by calling our Customer Service department, or you can send a copy of the notice from the patients former carrier that includes this information. For full time students, enter the name of the school and the city in which it is located on the claim. Contact your company's human resources department. Sacramento, CA 95853-7007 "Delta Dental" refers to the national network of 39 independent Delta Dental companies that provide dental insurance. Unscheduled dressing change, Procedure codes: You may be responsible for the cost of procedures or services not covered by your plan. See Related Links below for information about each specific fee schedule. All Rights Reserved. (2) Out of Network Range: This range is intended to assist you in understanding 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. 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 Delta Dental has the largest network of dentists nationwide. 465 Medford Street, Ste 400. Otherwise, the natural parent the child lives with provides primary coverage. Dental Finishing Supplies | You will receive the discount off the providers usual and customary Depending on the state, maximum contract allowances are derived from a variety of factors, including data from fees on claims, fee filings submitted by dentists (not applicable for Delta Dental of Pennsylvania), current economic factors and/or other data. That was pretty easy. You will be notified separately when processing of secondary coverage is completed. Be sure to enter the treating dentists license number or National Provider Identifier (NPI). If the patient is a dependent with a disability, enter the nature of the disability. If you are experiencing a medical or dental emergency, you should seek appropriate emergency medical or dental assistance, such as calling "911." Complete the application and follow instructions to submit either online or by mail. estimate is recommended before the start of extensive dental treatment. Have a question about coverage or looking for dental insurance? Help the dental consultant review your claim. Estimates may vary depending on your benefit plan and the state you live in. Claims will be processed when received according to your plan provisions. Look Up a ZIP Code . Smiles For Children (SFC) pregnant individuals enrolled in Medicaid and FAMIS MOMS who are 21 years of age and older 600 East Broad StreetRichmondVirginia. Obtaining your NPI is simpleand once obtained, it stays with you for life. Coordination of benefitsis the process insurance companies follow to ensure that the combined benefits from all group dental plans do not exceed 100% of the dentists fee. The Dental Care Cost Estimator provides an estimate and does not guarantee the exact fees for dental procedures, what dental benefits your plan will cover, or your out-of-pocket costs. You have entered an Invalid User ID and/or Password. Six-digit dates with no spaces, slashes or dashes (for example, 120320 for December 3, 2020). Please indicate the total amount paid by the primary carrier on the face of a paper claim or in the comments/notes section of an electronic claim and attach a copy of the Explanation of Benefits from the primary carrier. Dental Office Supplies & Essentials | All of those matters are things that you should decide, in consultation with your dental care professionals. Some Delta Dental groups that are not subject to the provisions of California Health and Safety Code 1374.19 have a non-duplication of benefits clause in their contract. Estimates should not be construed as financial or medical advice. Dental Pins | Refer to your benefit plan to determine whether preventive services are covered for you. Look at you smiling. If a court order makes one parent more financially responsible, that parent provides primary coverage. Online Dental Supply Company | Dental Supply Store | Dental Companies | You should always talk to your health care professionals for information concerning diagnosis and treatment, including information regarding which drugs or treatment may be appropriate for you. Periodontics (including scaling and root planing), Description of service: Here's what you need to know about NPIs. Want to know before you set foot in the dentists office? 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 This will lead you to the claim adjustment form, where you can indicate the issue(s) that needs to be addressed with your claim, provide necessary details and upload supporting documentation. 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. Daniel Ribeiro , Dentist has not yet specified details about his education and training. D3310-D3330, D3921. Dental Digital Radiography & Digital X-Ray Equipment | These listings are updated on a regular basis, and every effort has been made to ensure that only participating active providers are listed. Mailing addresses for your Delta Dental Premier and Delta Dental PPO claims. We often hear Henry Schein customers state that they arent concerned with balancing UCR fees because they participate with various dental benefit providers. Delaware, District of Columbia, Maryland, New York, Pennsylvania and West Virginia: E-mail:ddpdentist_services@deltadentalpa.org Then, select the Submit Claim icon under Actions. Coverage received as an active employee is primary. If you or the patient receives more than 100 percent of the fee, the amount in excess should be refunded to the secondary carrier. We offer vision coverage through DeltaVision in 15 states and the District of Columbia. Mail to: or Fax to Actuarial: Delta Dental of Minnesota 1 -877 631 8954 . The national network of Delta Dental companies protects more smiles than any other dental insurance company. Click on the specialty link for the location you want to view. These plans are not considered to be qualified health plans under the Dental Periodontic Products | Daniel Ribeiro , Dentist has not yet specified details about his residency. After you register, claim your free Doctor.com profile to expand your reach online. Your actual cost may be higher or lower than the estimate for various reasons. If you are not submitting claims electronically, talk with your practice management system vendor about activating your systems electronic claims component. Universal Composites | Miscellaneous services. My Contracted Fees 1. Delta Dentals allowance for orthodontic procedures includes all appliances, adjustments, insertion, removal and post-treatment stabilization (retention). App features may vary by geographic area and individual dentist participation. To check that your provider participates, visit our website or call us. However, you may not assign amounts due from Delta Dental to any other entity, such as an accounts receivable agency. All individual health care providers (including dentists) and organizations such as clinics and group practices are eligible to obtain an NPI. * All pre-treatment radiographs, photographs and charting should be within 12 months of the planned treatment unless otherwise specified. An NPI is required by the federal Health Insurance Portability and Accountability Act (HIPAA) for electronic transactions. NextStep Latex Glove | Dental Laser - Diode Lasers | Refer to your benefit plan to determine whether these requirements apply to you. However, we do suggest that you refer your patients to a Delta Dental Premier participating specialist to minimize your patients' out-of-pocket costs. only. simple just enter your dental service providers office zip code, then click on Select the patient, then select the Submit Claim icon in the Actions menu. based on the circumstance and specialty of the Provider. Oral health habits Prosthodontic Instruments & Supplies | Once you're a member, you will be provided with a complete fee schedule (applicable for most plans) with discounted fees for nearly every dental procedure. AARP Dental Insurance Plan c/o Delta Dental Insurance Company Watch the video below for an overview of the new dental health coverage for adults. DeltaCare USA 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. 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. Sign in to get a more accurate range that includes in-network savings. If there is any conflict or discrepancy between the Content on this website and your coverage documents, your coverage documents will control. For joint custody, the plan that has covered either stepparent longest provides primary coverage. Do not submit documentation with other procedures (unless Delta Dental specifically requests it). Once you're a member, you will be provided with a complete fee schedule (applicable for most plans) with discounted fees for nearly every dental procedure. Federal Employees Dental Program . Get started here. How much is it going to cost? This helps ensure that you dont contribute to higher costs that can potentially jeopardize patients dental benefits plans. When this occurs, please submit only one claim to the Delta Dental company. DeltaCare USA's payer identification number for encounter forms is DDCA3. In some cases it may be determined that This website shows estimates of certain dental care costs. Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code. Unfortunately, we cannot provide pre-treatment estimates by telephone. does not apply for dental service providers that participate with MetLife through Enter your patients name and choose Existing (or enter a new patients information). Allowances will differ depending on the type of plan. They have fee schedules "approved" at Delta and Blue Cross, but they do not participate in managed care. Pre-authorizations or referrals are required for certain benefit plans and certain dental care providers. Example: Crown lengthening, Description of service: Delta Dental had "allowed" $41 for full reimbursement for a two-surface amalgam (D2150). Like most dental benefit plans, MetLife's dental plans Look Up a ZIP Code. Dental Preventive Products | 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). If any data related to your NPI changes (name, address, etc. Orthodontics Supplies & Tools | 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. Copyright 2023 Delta Dental Plans Association. A current spouse and an ex-spouse: The current spouses coverage is primary (unless a court order makes the ex-spouses plan primary). How maximum contract allowances are determined, How maximum contract allowances are updated. Already have a dentist? 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. Example:If you replace a crown that is less than five years old, anticipate the obvious question and explain what event or circumstance made the replacement necessary. Chart notes including periodontal case type and diagnosis. Saving money by eliminating printing, copying and mailing costs. Dual coverage with the same Delta Dental company, California rule for coordination of benefits, How to request a real-time pre-treatment estimate, What to include on an orthodontics treatment claim. Or, you may mail a paper claim to Delta Dental. whose birth date is earlier in the year provides primary coverage. The version of the Cost Estimator that is available publicly (does not require sign-in credentials) uses aggregated historical cost data for the procedure in question. Is there a charge to join any of your networks? Nothing on this website guarantees eligibility, coverage, or payment, or determines or guarantees the benefits, limitations or exclusions of your coverage. 23219For Medicaid EnrollmentWeb: www.coverva.orgTel: 1-833-5CALLVATDD: 1-888-221-1590. However, contracted Delta Dental dentists may not charge their Delta Dental patients more than the amount determined by Delta Dental to be the patients portion. Health information changes quickly. First, select the patient. Please consult with the respective plan detail page for additional Protect my smile Dental procedures When do you need a root canal? members under age 21 are covered for all medically necessary dental services pregnant individuals enrolled in Medicaid and FAMIS MOMS who are 21 years of age and older DMAS - Department of Medical Assistance Services, Breast & Cervical Cancer Prevention and Treatment Act, Addiction and Recovery Treatment Services, Hospital Presumptive Eligibility Information, Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Behavioral Health Service Utilization and Expenditures, Legislative and Congressional District Reports, Monthly Expenditure Reports of the Medicaid Program, Nursing Facility Value-Based Purchasing Program, CHIP State Plan and Waiver-Related Documents, Learn more about how you can use Smiles for Children insurance, | | s -w-po-ny | | | Deutsch | | Tagalog | Franais | | Igbo asusu | | | Espaol | | Ting Vit | Yorb. Dental Patient Financing | Dental Financing | Document exceptional or unusual circumstances only in the Remarks or Comments field of the claim. Oral surgery (excision of lesion), Procedure codes: Send the information to your inbox and check at your convenience. Daniel Ribeiro , has not yet specified details about his residency. 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. Read our Fact Sheet to learn more: Smiles for Children Member Brochure (Spanish), Smiles for Children Adult Dental Benefit FAQs, Adult Dental Services for Virginia Medicaid Members - Webinar, Adult Dental Services for Virginia Medicaid Members - Slide Deck Announcing Benefit, Adult Dental Services for Virginia Medicaid Members - Slide Deck Announcing Benefit (Spanish). A spouse or domestic partners plan is secondary. Mailed applications may require up to 20 days to process. The Content cannot, and is not intended to, replace the relationship that you have with yourhealth careprofessionals. Connect with your Delta Dental to learn more. Pre-authorizations or referrals are required for certain benefit plans and certain dental care providers. Pre-treatment estimates are especially beneficial when expensive or extensive treatment is being considered and/or dental plan annual maximum, limitations and/or exclusions may affect coverage. The NPI contains no embedded intelligence no coding that would identify the dentists state or license number, for example. The sample table above is a small selection of common procedures discounted by these discount dental plans and programs. Delta Dental has the largest network of dentists nationwide. Therefore, it is always best to confirm information with yourhealth careprofessionals. Survey of Dental Fees This exclusive survey provides you with an analysis of self-reported fees by procedure from a nationwide, random sample of dentists. Therefore, it is always best to confirm information with yourhealth careprofessionals. Tubing Suction Connect | Minneapolis, MN 55440-9304 . Customers can upgrade any fee analysis to a complete Henry Schein Practice Analysis for an additional $99 per zip code. zip code. Oral Cancer Screening Light Tool | Identafi | Our Dental Care Cost Estimator tool provides estimated cost ranges for common dental care needs. This causes the dental carrier to cover the patient's share of the fee. Also, this will help ensure that Delta Dentals calculation of the patients portion takes into account all available benefit information. DentalPlans.com makes it easy for dentists who accept Dental Savings Plans from one or more of our network partners to confirm patients plan membership. There is no need to resubmit the claim. 0 For more information about electronic encounter form submission, please email ourEncounters department. For a complete description of the details of your coverage, please refer to your coverage documents. Cost estimates for services provided by out-of-network dentists (available in the out-of-network estimator) are based upon submitted claims data for out-of-network providers. Keep in mind, a pre-treatment estimate is not a guarantee of payment and it does not check the patients: At any time, you can review the patients current eligibility and benefits information, including remaining maximum and deductible amounts. Use these tips for clear, complete paper claims that will move smoothly through our system. Contact DentaQuest at 1-888-912-3456 or search the DentaQuest website to find a listing of dentists who accept Medicaid in your zip code. Learn more about how you can use Smiles for Children insurance. Click View contracted fee reports 2. The benefit is based on theapproved fee for conventional orthodontics. Special promotions including, but not limited to, additional months free are not available This can jeopardize the stability of the patients dental coverage by driving up costs because we assume the overbilled fee to be accurate, then base our premiums on inflated dental costs. 118 0 obj <> endobj Please Note: The information displayed below is not a guarantee of coverage, and Two jobs or two retiree plans: The plan that has covered the employee longest is primary. by MetLife guidance in understanding your dental service providers fees. a patients eligibility and benefits will only be determined at the time of a claim 3. Dental Infection Control Supplies & Products | Dental Burs & Diamond Burs | This means Delta Dental has overpaid weve paid 100% of $80 instead of 80% of $80. Find the one thats right for you. They will update your records with Delta Dental in other states. If the fathers birth date is 10/3/67 and the mothers birth date is 5/15/68, then the mothers coverage is primary.