*Not sure where your company is headquartered? 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. To be sure, please refer to your dentist handbook. Log in here Dental Finishing Supplies | Therefore, it is always best to confirm information with yourhealth careprofessionals. From there, you can transmit claims, digitized attachments and pre-treatment estimates with either of these tools: You can also useFastAttach, a service available through National Electronic Attachment, Inc. (NEA), to electronically transmit digitized x-rays, periodontal charts, Explanation of Benefits documents, photos and narratives. If you . 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. 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. Watch the video below for an overview of the new dental health coverage for adults. All Rights Reserved. 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. Delta Dental has the largest network of dentists nationwide. Estimates should not be construed as financial or medical advice. Pre-treatment estimates often process within moments (when clinical review isnt required), so you can talk with your patients about treatment plans while they are still in your office. Photocopied claims that are blurred or skewed. 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. It is a good idea to let us know when a patient no longer has dual coverage. 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. 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. Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania and affiliates, Submitting claims for dependents age 19 and over, Electronic encounter forms for DeltaCare USA. Dental Reminder Postcards and Filing Office Supplies | Click the ">" to move your selection to the box on the right side. ), Birth date for the patient and eachmember, If parents are divorced, the parent with whom the child lives, When Delta Dental is the secondary carrier, Explanation of Benefits (EOB) from the primary carrier. This cost estimator is intended for use in the 50 states, Puerto Rico and other U.S. territories. Delta Dental had "allowed" $41 for full reimbursement for a two-surface amalgam (D2150). Delta Dental Premierand Delta Dental PPO Claims. The AMA does not directly or indirectly practice medicine or dispense medical services. Articulating Paper for Occlusal Contacts & Forces | Customers can upgrade any fee analysis to a complete Henry Schein Practice Analysis for an additional $99 per zip code. Our Dental Care Cost Estimator tool provides estimated cost ranges for common dental care needs. 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. Provisional splinting, Description of service: We offer vision coverage through DeltaVision in 15 states and the District of Columbia. 4. MEMBER FEE SCHEDULE MEMBER PAYS DENTAL SERVICE (Maximum Charge) Delta Dental of Illinois DDIL.PD.FS.0802 Diagnostic Services D 0120 Periodic oral evaluation $23 D 0140 Limited oral evaluation-problem focused $34 . The sample table is a small selection of common procedures discounted by these discount dental plans and programs. The information and content (collectively, "Content") on this website is for your general educational information only. 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. Periapical radiographs - pre- and post-operative. endstream endobj startxref Be sure to submit dual coverage information on claims for orthodontic procedures, even if the other insurance does not cover orthodontics. Looking to cover yourself or your family? actual fees that your dental service provider may charge may be higher or lower You will receive by mail a pre-treatment estimate showing the amount Delta Dental is estimated to pay and the amount of the patients responsibility. In such cases, its important to understand that a recommended treatment may be perfectly appropriate. Smiles For Children (SFC) pregnant individuals enrolled in Medicaid and FAMIS MOMS who are 21 years of age and older 600 East Broad StreetRichmondVirginia. Oral Cancer Screening Light Tool | Identafi | An itemized Explanation of Benefits is required for all procedures when Delta Dental is the secondarycarrier. Dental Office Forms - Perio Charting Forms | The information and content (collectively, "Content") on this website is for your general educational information only. If you or the patient receives more than 100 percent of the fee, the amount in excess should be refunded to the secondary carrier. 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. Discounted fees listed under "Routine Dental Fees", "Fillings & Crowns" and Root Canals, Perio & Dentures tabs are for participating General Dentists. Save time and money while helping the environment by electronically submitting your encounter forms to DeltaCare USA. Oral surgery (excision of lesion), Procedure codes: Our Dental Care Cost Estimator tool provides estimated cost ranges for common dental care needs. Dental Preventive Products | 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 make it easier for you, your fees for these visits are included in the total fee you submit on the claim for banding and in the periodic payments you automatically receive from Delta Dental. A full time job and a part time job: Coverage through the full time job is primary. Dental Restoration: Dental Bridges, Crowns & Posts | The patient is responsible for their coinsurance/copayment portion only. 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. Sacramento, CA 95853-7007 by MetLife guidance in understanding your dental service providers fees. Other clauses in the contract along with documents referenced in the contract (i.e., the provider's office reference Members have a fixed copayment for all covered services and cannot be balance billed. Use of this website in no way increases or decreases the benefits available under a dental benefit plan. In this case, generally, the plan through current employment is primary. 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. Fax: 717-774-1770 Dental Digital Radiography & Digital X-Ray Equipment | 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). The AMA assumes no liability for data contained or not contained herein. Latex Free Exam Gloves | 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). 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. TechCentral - Advanced Technology Solutions and Dental IT Support | 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. For more details see our privacy policy. Sign in to get a more accurate range that includes in-network savings. AARP Dental Insurance Plan c/o Delta Dental Insurance Company 0 Daniel Ribeiro , Dentist has not yet indicated the hospitals that he is affiliated with. The procedures discounted under these plans and programs offer similar savings to the sample above. Anticipate what questions a dental consultant may have regarding a particular claim and provide the reason it should be paid. hb```g``Zpj1 X{ y `` Dental Supplies & Specialty Products | plan terms. For example, allowances for Delta Dental PPO are different in most cases from those for the Delta Dental Premierplan. Please re-enter. Mailed applications may require up to 20 days to process. Enter the required documentation information in the Remarks or Comments field of the claim. Federal Employees Dental Program . P.O. From a cleaning and an X-ray, to a crown or a root canal, the tools lets subscribers search by ZIP code and dentist to find the best price by procedure. You should update your fees at least annually. You can submit a request for a claimadjustment. Email: CustomerCare.Credentialing@greatdentalplans.com. Enter a corporate or residential street address, city, and state to see a specific ZIP Code . Do you use the Internet to obtain eligibility and benefits information or check on the status of claims? Reasonable efforts include: Maximum contract allowances are the total reimbursement amounts, under the member's benefit plan, on which Delta Dental calculates its payment and the patients financial obligation. simple just enter your dental service providers office zip code, then click on These updates are required to be filed first for approval by state regulatory agencies in many locales. We update them regularly, usually every 6 to 24 months. estimate is recommended before the start of extensive dental treatment. App features may vary by geographic area and individual dentist participation. Want to know before you set foot in the dentists office? The Henry Schein Fee Analysis provides dentists and dental professionals with the latest UCR (Usual, Customary, and Reasonable) fees for the zip code of your choice. The NPI contains no embedded intelligence no coding that would identify the dentists state or license number, for example. More Information On Dental Supplies | To find Delta Dental Insurance Company Or, you may mail a paper claim to Delta Dental. A pretreatment estimate is recommended before the start of extensive dental treatment. Your National Provider Identifier (NPI) is an important number for all providers to have in order to successfully submit claims with Delta Dental. 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). You may be responsible for the cost of procedures or services not covered by your plan. Include all patient information on claims. Type 1 or Type 2 - Which NPI is right for you? 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. Fees with decimal points (for example, 100.00; not 100). The Content on this website is not medical advice. whose birth date is earlier in the year provides primary coverage. Maximize your oral health and make the most of your dental benefits right from your mobile device by downloading the Delta Dental Mobile App. You have entered an Invalid User ID and/or Password. After confirmation of the receipt of your application, you should receive your NPI via e-mail within one to five business days if you submitted the application online. Any additional fee for the nontraditionalmethod is not billable to the patient. Consult with your provider prior to beginning any treatment. Dental Evacuation | Oral Surgery Instruments, Anesthetic & Supplies | For DeltaCare USA, maximum contract allowances are not applicable. For further assistance, please contact E-Commerce Technical Support at 1-800-711-6032, Monday through Friday between 8:00am-8:00 pm ET. Miscellaneous services. Dental Forceps & Extraction Tools | Dental Acrylics - Acrylic Resins | Department of Medical Assistance Services. The combined payments by all plans may not exceed the total fee for the treatment. 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. View plans, sample savings & pricing, patient reviews & practice information. The Content on this website is not medical advice. fees when you pay. 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.