A. There are numerous advantages to joining the Delta Dental networks. Delta Dental focuses on getting patients into your office on a regular basis—for their benefit and yours. Joining our networks gives you national exposure to a large potential client base. Your practice will be listed in our national dentist search and directories, and subscribers have an incentive to visit a participating dentist as they general have lower out-of-pocket expenses when they do. And, research shows insured people visit their dentist twice as often as those without insurance. Another benefit is easy administration. Participating Delta Dental dentists are paid directly when treating Delta Dental subscribers, and our quick, accurate claims processing means you'll be paid quickly and easily.
A. Yes, by signing a Delta Dental Participating Provider Agreement with your local member company, your participation is honored throughout the national Delta Dental System. Please keep in mind that patient claims must be submitted to the appropriate Delta Dental member company for processing, not your local member company. You can determine eligibility for all Delta Dental subscribers by logging in to the Dentist Connection on our national website.
A. In many cases, your patient will still receive benefits, but he or she may have more out-of-pocket expenses. Your patient may also have to pay you up front for services and wait to be reimbursed by Delta Dental. However, patients with DeltaCare, our DHMO plan, as well as some exclusive PPO plans, must visit a participating provider to receive benefits and will be responsible for the full cost of your services.
A. Yes, if you are a Delta Dental participating provider. In order for us to maintain accurate records, you are required to notify your Delta Dental member company's professional relations department, in writing, of any changes to your practice. Your member company may have a form available for this sort of information. Changes may include:
your tax identification
a new dentist practicing in your office
a dentist leaving your office
any other office in which you practice
Please note that changes are not automatically made when claims are submitted. Failure to notify us of these changes may result in payment delays or payments being sent to the patient.
A. If you are unsure which network(s) you are a member of, use our national Dentist Search to check your directory listing or contact your local member company. This information is very important because it determines how your patient's benefits are paid. When a patient asks if you participate with Delta Dental, please be specific about which Delta Dental network you participate in. This will help your patients understand correctly the benefits they will be entitled to with their dental plan.
A. Delta Dental Premier® is one of our three contracted national network based programs. Participating dentists agree to adhere to Delta Dental processing policies and are prohibited from billing a patient above the pre-negotiated fee, accepting billing under these terms as payment in full.
The network is made up of more than 142,000 dentists practicing in more than 251,000 locations throughout the United States and its territories.
A. Delta Dental PPOSM is one of our three contracted national network based programs. Participating dentists agree to fee schedules as payment in full.
As with all of the Delta Dental networks, dentists agree to processing policies and are prohibited from billing and collecting fees in excess of the agreed upon schedule. This product allows enrolled patients to visit any dentist but offers additional savings when visiting a Delta Dental PPO network dentist.
The network is made up of nearly 84,000 dentists practicing in more than 168,000 locations throughout the United States and its territories.
A. DeltaCare® USA is Delta Dental's national Dental Health Maintenance Organization (DHMO). Enrolled patients must select from the DeltaCare network of primary care dentists. These dentists manage their patients' comprehensive dental needs, including referrals to specialists, which earns each dentist a monthly capitation amount. The DeltaCare USA network currently has more than 39,800 dentist office locations.
A. You can access your patients' benefits and eligibility by logging in to the Dentist Connection on our national website. You will need the patient's subscriber ID or social security number, name and date of birth. You may also contact a benefit services representative at your Delta Dental member company.
A. You can check your patient's benefits and eligibility by logging in to the Dentist Connection on our national website. You will need the patient's subscriber ID or social security number, name and date of birth.
A. A patient's subscriber ID may be their social security number or a plan assigned ID, group assigned ID or alternate ID. If your patient was not provided a subscriber ID or doesn't remember it, try using their social security number. If that doesn't work, we recommend contacting the Delta Dental member company that provides their coverage.
A. Typically one of the dental plans will be considered the primary plan for your patient. This plan will pay towards their dental care first. Any additional plans that they are covered under will pay towards whatever portion is remaining. Your patient's plan information will have a coordination of benefits provision that explains how it is handled by their plan. Regardless of how the coordination is handled, the plans cannot pay more than 100 percent of the cost of treatment.
A. Claims need to be sent to the member company which provides your patient's benefits, not the local member company you've signed a participation agreement with. You can confirm your patient's member company by logging in to the Dentist Connection on our national website. You can also download claim forms for each member company on our secure dentist portal. Once you've determined which member company to send the claim to, you can find the claims address for each member company on our website as well.
A. Currently, Delta Dental processes all claims in less than three business days on average from the date the claim is received. Each member company processes claims independently so the turnaround time may vary slightly across the country.
A. You may view claim status at any time on our national website. Simply register for an account if you do not already have one. Once you have an account, login to the site and click the "Claim Status" link which is visible on the left side of the screen. You may also contact customer service at the Delta Dental member company that you submitted the claim to.
A. Submitting a monthly claim for orthodontics is not necessary. Normally, the claim is filed for the entire treatment, and Delta Dental automatically makes a payment each month until the treatment is completed, terminated, or the patient is no longer eligible.
A. You can access benefits and eligibility information and claims status at any time by logging in to the Dentist Connection section of our national website. Local member company customer service department hours vary. Our customer service inquiry tool can help you look up the contact information for each member company or submit an online customer service request.
A. Providers or their office staff can register for an account. You'll need your name and the provider's name (if different), your business tax ID and the provider's license ID, and address to set up your account. Once you've registered, you'll have access to patients' benefits and eligibility information and your claims status for a limited time. You'll receive a confirmation of your account via email or mail, and will need to enter an authorization code in order to keep your account active.
A. If you forget your username or password, there are links under the login box to help you retrieve your username or password. You'll need to know your business tax ID, provider license ID and provider name in order to retrieve them.
A. Our national website is a great place to check your patients' benefits and eligibility and view claims status regardless of which member company covers your patients. However, some member companies offer more information and additional tools on their websites than we do on deltadental.com, so you may benefit from visiting their site to access these additional services. In many cases, you can log in at deltadental.com and be directed to your member company without having to log in a second time.