Coverage received as an active employee is primary. Glossary. Enter city and state to see all the ZIP Codes for that city. Dental Scalers, Power Scaler & Dental Curettes | Allowances will differ depending on the type of plan. Fax: 717-774-1770 Currently, the tool provides the total cost of the procedure; however, in the near future it will also show Delta Dental subscribers their actual out-of-pocket costs. Cost estimates are specific to geographic areas, as defined by the first three digits of a ZIP code (e.g., the geo ZIP for 12345 is 123). 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. Look Up a ZIP Code. Smiles for Children (SFC) is Virginia's Medicaid and FAMIS dental program for adults and children. Actual fees charged by your provider may vary for a variety of reasons. Maximize your oral health and make the most of your dental benefits right from your mobile device by downloading the Delta Dental Mobile App. Resources. Simplylog in to Provider Toolsand select "My claims." Chart notes including periodontal case type and diagnosis. Preventive Products: GC MI Paste Plus, Colgate PreviDent, PreviDent | View plans, sample savings & pricing, patient reviews & practice information. 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. *Not sure where your company is headquartered? Refer to your benefit plan to determine whether preventive services are covered for you. Document exceptional or unusual circumstances only in the Remarks or Comments field of the claim. The Content on this website is not medical advice. Other clauses in the contract along with documents referenced in the contract (i.e., the provider's office reference Alpharetta, GA 30023. standard processing guidelines and reviews. Photographs must accompany radiographs when determining cracked teeth, build-ups, crowns, and anterior restorations when evidence of necessity is not obvious on the radiographs. Delta Dental recommends that the NPI be used on all claims. Delta Dental of Minnesota provider forms for claims and remittance, dental office support, participation agreements and government programs. Dental Adhesives: Dental Cements & Dental Liners | For javascript disabled viewers - The address for our administrative office is: Delta Dental of California . The federal Health Insurance Portability and Accountability Act (HIPAA) requires you to obtain an NPI if you submit claims electronically or if you check claims status or access patient eligibility and benefits information online. 157 0 obj <>stream The SFC program is managed by Dentaquest. Dental Tools & Instruments - Hand & Surgical Instruments | Extraction - Impacted Wisdom Tooth (Soft Tissue), Extraction - Impacted Wisdom Tooth (Partial Bony), Add Clasp to Existing Bridge (Partial Denture), Tooth Replacement Part of Permanent Bridge, 25739 Branch Rail Dr Ste 160 Chantilly, VA 20152, 7764 Armistead Rd Ste 100 Lorton, VA 22079, Nevermind, take me back to DentalPlans.com, Full Orthodontic Child Treatment (Braces), Full Orthodontic Adult Treatment (Braces), Surgical placement of implant body: endosteal implant, Abutment supported cast metal crown (predominantly base metal). Box 1810 Delta Dental Patient Direct coverage is not available in all 50 states. Also, this will help ensure that Delta Dentals calculation of the patients portion takes into account all available benefit information. We offer vision coverage through DeltaVision in 15 states and the District of Columbia. 142 0 obj <>/Filter/FlateDecode/ID[<50BF235CB0813E4C89D853A2B2492B60><1D4202BFC1803A4BB7FE6E056AB3B3AE>]/Index[118 40]/Info 117 0 R/Length 115/Prev 160342/Root 119 0 R/Size 158/Type/XRef/W[1 3 1]>>stream Dual coveragerefers to when a patient's dental treatment is covered by more than one dental benefits plan. 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. Send the information to your inbox and check at your convenience. Here are the benefits of creating an account. An itemized Explanation of Benefits is required for all procedures when Delta Dental is the secondarycarrier. For assistance call 1-800-372-4346, 8:00am-8:00pm ET. actual fees that your dental service provider may charge may be higher or lower Oral health habits M-T 8:30a-10p | F 8:30a-9p | Sat 9a-6p | Sun 10a-4p EST. At Henry Schein, you can Rely on Us for all of your dental practice needs. Use of this website in no way increases or decreases the benefits available under a dental benefit plan. For more information about electronic encounter form submission, please email ourEncounters department. 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. Box 2105 Some procedures are not covered under your patient's plan, no matter what documentation is submitted. If you do not agree with Delta Dentals determination of benefits, and you have additional information to provide, you may request reevaluation by submitting: Mail this information to theDelta Dental member companythat originally processed the claim or pre-treatment estimate. 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. With electronic claims submission, your claims are automatically edited for missing or invalid information before they are sent to carriers. Unscheduled dressing change, Procedure codes: How maximum contract allowances are determined, How maximum contract allowances are updated. If you live outside the U.S., you may see information on this cost estimator about products or services that are not available or authorized in your country. Doctor.com powers the first vertical network that connects patients and healthcare providers across the web. Preventive services are included in this tool. Use Provider Tools to avoid surprises with a free, real-time pre-treatment estimate. Expand and personalize your practice's online profile, Provide affordable solutions to un-insured patients, Reduce administrative headaches; get paid at the time of service. Enter the NPI of the billing dentist or dental entity, as well as the treating dentists NPI (if they are different). For more detailed information on your actual dental care costs, please consult your dentist or your Delta Dental. Contact your company's human resources department. For example, if a retiree is employed, the active coverage is primary; the coverage resulting from retirement is secondary. Our Dental Care Cost Estimator provides estimated cost ranges for common dental care needs. By clicking, you agree that you have read the informationbelow,are accessing this information for purposes of determining treatment cost estimates for dental care services you are considering receiving, and will not use the information in this tool for a commercial or anti-competitive purpose. 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. endstream endobj startxref Note not all plans and an alternative method of treatment is as appropriate and cost-effective. Dental Periodontic Products | For more detailed information on your actual dental care costs, please consult your dentist or your Delta Dental. You'll be receiving an email with the information you've requested shortly. Rubber Dam | Rubber Dam Clamps | Example:If the dentist submits a fee on a claim for $120, and the maximum contract allowance is $100, Delta Dental will calculate its payment and the patients payment based on $100. For extensive or unusual services, what would you need to understand why a patient needs a particular treatment? Special promotions including, but not limited to, additional months free are not available only. Please contact the Delta Dental company below for more information. The amount that would have been payable by Delta Dental may not be charged to the patient. 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. P.C., (Adam Diasti, DDS, DN11634) or Coast Dental of Texas, PC (Adam Diasti, DDS, Lic 32327) Coast Dental Services, LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Copayment waivers are a form of overbilling the dental carrier. Please note that this fee "Delta Dental" refers to the national network of 39 independent Delta Dental companies that provide dental insurance. Dental Pins | 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. Always notify Delta Dental of the actual fee charged. Daniel Ribeiro , has not yet specified details about his residency. Connect with your Delta Dental company to learn more. Please register your NPI with Delta Dental by providing us with a copy of the confirmation containing your NPI that you receive from the National Plan & Provider Enumeration System (NPPES). Estimates may vary depending on your benefit plan and the state you live in. Privacy Statement Terms of Use Social Media Policy. Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas, Utah and U.S. Virgin Islands: E-mail:ProfessionalServices@ddic.delta.org Description of service: Thoroughly complete the claim with clear, legible information. 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. Confidential Filed Fee Schedule Six-digit dates with no spaces, slashes or dashes (for example, 120320 for December 3, 2020). If you or the patient receives more than 100 percent of the fee, the amount in excess should be refunded to the secondary carrier. Preventive services are included in this tool. Looking to cover yourself or your family? 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. Dental coverage is now available for adults! Or, you may mail a paper claim to Delta Dental. Connect with your Delta Dental to learn more. Maximum contract allowances will differ by 5-digit ZIP code. 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. Compare your fees to the 40th - 95th . The 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. Pre-authorizations or referrals are required for certain benefit plans and certain dental care providers. Dental Office Dcor Reception Room Furniture | A pretreatment Delta Dental may also terminate the dentists participation agreement if a dentist regularly waives patient copayments. X, 19Ys = L L.NP) t\&=L L ;u Patients may change their coverage, usually in the fall or spring, during their open enrollment periods. 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). Refer to your benefit plan to determine whether these requirements apply to you. If the claim does not have this field, please list each item on a separate line. They have fee schedules "approved" at Delta and Blue Cross, but they do not participate in managed care. Type in the zip code of your choice and balance your fees right from the start! Waiving copayments violates the contracted dentists participation agreement with Delta Dental as well as the patients dental benefits contract. A pretreatment estimate is recommended before the start of extensive dental treatment. who participate in MetLife's Preferred Dentist Program will charge, but may vary Please consult with the respective plan detail page for additional Lysol IC Spray | *Not sure where your company is headquartered? For joint custody, the plan that has covered either stepparent longest provides primary coverage. Dental Staff Education | Here are some suggestions to speed up claim payments. Also, medical coverage would be primary if the group dental plan contract indicates that specific oral procedures are covered (such as a biopsy, oral surgery provided by a physician or dental treatment provided in a hospital). P.O. The national network of Delta Dental companies protects more smiles than any other insurance company. By clicking, you agree that you have read the informationbelow,are accessing this information for purposes of determining treatment cost estimates for dental care services you are considering receiving, and will not use the information in this tool for a commercial or anti-competitive purpose. All Rights Reserved. Estimates should not be construed as financial or medical advice. These listings are updated on a regular basis, and every effort has been made to ensure that only participating active providers are listed. 3. 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). Mechanicsburg, PA 17055-2059. Dental Products - Professional Services | 23219For Medicaid EnrollmentWeb: www.coverva.orgTel: 1-833-5CALLVATDD: 1-888-221-1590. Dental Reminder Postcards and Filing Office Supplies | Dental Patient Education | Dental Patient Communications | Learn more about how you can use Smiles for Children insurance. You may be responsible for the cost of procedures or services not covered by your plan. For more details see our privacy policy. Tubing Suction Connect | Indication if this is an initial claim or a transfer case. Massachusetts dentists have a few options: Mail: Provider Enrollment and Credentialing Department (PEC) at Delta Dental of Mass. %PDF-1.6 % %%EOF Daniel Ribeiro , has not yet specified details about his experience and accolades. Already registered with :DP Verify? 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. To begin using the Dental Care Cost Estimator tool, click the Agree button below. Dental Sleep Medicine - Sleep Apnea Prevention | If you . More Information On Dental Supplies | Delta Dental Your knowledge and expertise about dentistry will likely come across clearly if you remember that your audience is a dentist just like you. We do not return radiographic images or other documentation submitted with paper claims; however, we will make an exception when we receive a stamped, self-addressed envelope with the claim. 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. Compare your fees to the 40th 95th percentile, Up to date UCR fees for all U.S based dental practices. If there is any conflict or discrepancy between the Content on this website and your coverage documents, your coverage documents will control. Prosthodontics, fixed (bridge abutment crowns), Description of service: D7260, D7490D7521, D7530, D7540, D7610-D7780, D7910-D7912, D7980-D7983, D7998, Description of service: For other Delta Dental member companies, please check how they prefer to register your NPI. November 2018 Page 1 . * All pre-treatment radiographs, photographs and charting should be within 12 months of the planned treatment unless otherwise specified. If you dont conduct any electronic transactions governed by HIPAA, you arent required to obtain an NPI. How much is it going to cost? The AMA assumes no liability for data contained or not contained herein. Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code. 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. When premiums increase, groups may consider dropping dental benefits altogether. A spouse or domestic partners plan is secondary. Dental Infection Control Supplies & Products | Orthodontics Supplies & Tools | When children are covered through remarriages/domestic partnerships, coverage is determined in this order: In the case of coverage through stepparents only: The stepparent the child lives with provides primary coverage. For full time students, enter the name of the school and the city in which it is located on the claim. Participation is free and all licensed dentists are eligible to participate. by MetLife guidance in understanding your dental service providers fees. We have coverage options designed to fit your business. Watch the video below for an overview of the new dental health coverage for adults. Use of this website in no way increases or decreases the benefits available under a dental benefit plan. Latex Free Exam Gloves | The Dental Care Cost Estimator sometimes groups together, into "treatment categories," services that are often delivered together to address a particular dental problem. Oral surgery (biopsy), Procedure codes: 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. App features may vary by geographic area and individual dentist participation. the START SEARCH button thats all you need! there is no paperwork or reimbursement, you must pay for the service at the time This causes the dental carrier to cover the patient's share of the fee. If you do not see the email in a few minutes, check your spam folder. Narratives must also be maintained as part of the patient treatment record. You may be responsible for the cost of procedures or services not covered by your plan. Periapical radiographs pre- and post-operative, Chart notes including periodontal case type and diagnosis, Narrative including necessity of treatment and mobility of teeth, Periapical or bitewing radiographs documenting bone loss, Narrative including necessity of treatment, Periapical or panoramic radiographs - current, Narrative including diagnosis, orthodontia type, and treatment length, Narrative for any exceptional cases and/or unspecified codes in all categories of service (D##99). Include the amount paid by the previous carrier on the claim. 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. Delta Dental will process the primary benefits, even if processing the secondary coverage must be delayed (for lack of eligibility data, for example). Prior approval is not required when you refer a patient to a specialist. Latex Exam Gloves | Dental coverage is now available for adults! Federal Employees Dental Program . Delta Dentals allowance for orthodontic procedures includes all appliances, adjustments, insertion, removal and post-treatment stabilization (retention). Oral Cancer Screening Light Tool | Identafi | A retiree plan and a spouses active plan: Usually, the patients retiree plan is primary (a persons own coverage is primary for himself/herself); however, check the Evidence of Coverage for the retiree plan there may be a provision making it secondary to an active plan. 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. Dental Evacuation | Health information changes quickly. Mailed applications may require up to 20 days to process. Lack of sufficient information, especially themembers ID number, is the most common reason for a delayed or denied claim. 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. Delta Dental network dentists are paid directly when they treat Delta Dental members, and our quick, accurate claims processing - ensures you'll be paid promptly and easily. Members have a fixed copayment for all covered services and cannot be balance billed. However, you may not assign amounts due from Delta Dental to any other entity, such as an accounts receivable agency. 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. If you receive notification that no payment was made because of late submission: Amounts due from Delta Dental may be paid to your professional corporation, partnership or association. Dental Office Forms - Perio Charting Forms | If the patient is a dependent with a disability, enter the nature of the disability. All of those matters are things that you should decide, in consultation with your dental care professionals. We can provide a plan thatll help ensure your smile stays healthy for years to come. Your Tax Identification Number (TIN, EIN or SSN). Oral surgery (impacted tooth), Description of service: Dental Supplies & Specialty Products | Like most dental benefit plans, MetLife's dental plans Daniel Ribeiro , Dentist has not uploaded any photos. Is there a charge to join any of your networks? Indicate a quantity (the number of x-rays, for example) in the field on the claim specifically for this purpose. Please do not submit original radiographic images if they are the only diagnostic record for your patient. Use new claim forms that accommodate the NPI by providing a specific space for it. estimate is recommended before the start of extensive dental treatment. The Henry Schein Fee Analysis can help you determine proper UCR fees for a given area well in advance of your grand opening. Call and make sure that your provider accepts Medicaid coverage so you can receive quality services at no cost. 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. Use your FastAttach connection, a service available through NEA, to electronically transmit digitizedx-rays, narratives, intra-oral pictures, Explanation of Benefits (EOB) Statements or any other document needed to adjudicate the claim. This means Delta Dental has overpaid weve paid 100% of $80 instead of 80% of $80. Universal Composites | Miscellaneous services. We update them regularly, usually every 6 to 24 months. Mailing addresses for your Delta Dental Premier and Delta Dental PPO claims. Find the one thats right for you. Every 12 months you may submit separate Delta Dental Premierfee updates for each practice location, specialty and TIN. 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. If the fathers birth date is 10/3/67 and the mothers birth date is 5/15/68, then the mothers coverage is primary. 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. This website shows estimates of certain dental care costs. Contact your company's human resources department. Fee discounts (including waiver of copayment/coinsurance) should be reflected in the total fee that is entered on the claim. Delta Dental. This is important because some services may be included in the patients basic coverage, even if the patient does not have specific orthodontic coverage. Before you start treatment, log in to your Provider Tools account and use the Submit Claim or My Patients tools to request a pre-treatment estimate. To begin using the Dental Care Cost Estimator tool, click the Agree button below. In this case, generally, the plan through current employment is primary. Copayment waiver is when a dentist enters a fee on a claim that includes a copayment that the dentist never intends to collect, which makes the reported fee artificially higher than the dentist's actual fee charged. All claims submitted are subject to MetLife's 0 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. Member perks for your smile and beyond All individual health care providers (including dentists) and organizations such as clinics and group practices are eligible to obtain an NPI. Dental Financing and Related Services | Dental Lab Coats | Fees may reflect combined fees from several different procedures into one procedure and may not be directly comparable to a specific benchmark in FAIR Health Data. Claims will be processed when received according to your plan provisions. 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. While many adults are unaware of how oral health and overall health are connected, most are interested in getting smarter about oral healths link to better health. Want to know before you set foot in the dentists office? If any data related to your NPI changes (name, address, etc. 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. Then, select the Submit Claim icon under Actions. When Delta Dental of California is the secondary carrier and is subject to the provisions of the California Health and Safety Code 1374.19, we pay the lesser of: (1) the amount we would have paid in the absence of any other dental benefit coverage; or (2) the member's out-of-pocket cost payable under the primary plan for benefits that are covered by the secondary plan. Save time and money while helping the environment by electronically submitting your encounter forms to DeltaCare USA. Implant supported prosthetics, Description of service: Discounted fees listed under "Routine Dental Fees", "Fillings & Crowns" and Root Canals, Perio & Dentures tabs are for participating General Dentists. The Content cannot, and is not intended to, replace the relationship that you have with yourhealth careprofessionals. than what is displayed. Everything you need to know about submitting Delta Dental claims. 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. Box 9304 . The Content cannot, and is not intended to, replace the relationship that you have with yourhealth careprofessionals. Example:If your fee for a service is $100 and you wish to give the patient a 20% discount, then $80 becomes the fee that is actually charged and $80 should be entered on the claim as the total fee.